Back Back
Key Studies at HIVR4P 2024
Research for Prevention: Key Studies to Look Out For at HIVR4P 2024

Released: October 04, 2024

Expiration: October 03, 2025

Beatriz Grinsztejn
Beatriz Grinsztejn, MD, PhD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • During the HIVR4P conference, studies will highlight the results and needs of HIV prevention care research across racial, ethnic, and gender diversities.

The International AIDS Society’s 5th HIV Research for Prevention Conference (HIVR4P) will address the biggest challenges and opportunities in HIV prevention. This is the only conference dedicated to the rapidly evolving field of HIV prevention research, such as vaccines, microbicides, pre-exposure prophylaxis (PrEP), treatment as prevention, and biomedical interventions. It will also explore the social and behavioral implications of these advances, the increasingly complex prevention landscape, and the next generation of research questions.

The insights shared at this conference will guide future efforts to end HIV as a threat to public health and individual well-being. Here are my thoughts on the presentations I am most looking forward to.

Location, Location, Location (and Representation)
I think it is important that this conference is being held in Lima, Peru, because it highlights the challenges that we are facing with the HIV epidemic across Latin America. The number of HIV infections have been increasing in Latin America in the last 15 years, and it is a different trend than what you see in other regions. HIV infections happen mostly in key populations, such as young men who have sex with men. This is why it is critically important that this conference is in this region to highlight the features of the HIV epidemic, and to highlight the importance of Peru, a country where these features are highly represented. 

This is one of the reasons I am excited to see the PURPOSE 2 details being presented by Jorge Gallardo-Cartagena. He will explore the global racial, ethnic, and gender diversity among the participants of the study using long-acting lenacapavir for PrEP.

The PURPOSE 2 study series assessed a wider population of participants than was usually seen. For instance, many other PrEP studies enrolled men who have sex with men and transgender women, but PURPOSE 2 also enrolled transgender men and nonbinary individuals to show how enrollment varied across global regions. I am especially interested in seeing whether there washow high the representation was from Latin America, as the study enrolled people from Argentina, Brazil, Mexico, Peru, South Africa, Thailand, and the United Sates.

We already know that the PURPOSE 1 study of lenacapvirlenacapavir for PrEP (in cisgender women in sub-Saharan Africa) was unblinded early because it met its efficacy endpoints. This September, PURPOSE 2 was also unblinded early because it met its endpoints of superiority over background HIV incidence and over once-daily oral PrEP, and I a’m looking forward to seeing these results presented at HIVR4P.

Real-World Implementation
For new and emerging long-acting injectable PrEP options like lenacapavir and cabotegravir, implementation is and will be a key factor. I expect that the most robust results shown will be from the real-world implementation of long-acting injectable PrEP from United States President’s Emergency Plan for AIDS Relief USAID’s District Coverage of Health Services project in Zambia.

From the United States, there will be an interesting study that explores the low-barrier, rapid implementation of cabotegravir in San Francisco. 

PrEP for Women: A Matter of Choice
It will be very exciting to have preliminary results from CATALYST, a large study with important collaboration between 5 countries in Africa (Kenya, South Africa, Zimbabwe, Lesotho, and Uganda). I am particularly looking forward to learning about early experiences of cisgender women being presented with different options for prevention: oral daily PrEP, dapivirine vaginal ring, or long-acting injectable cabotegravir. During this conference, the results will encompass the first 2 options: oral PrEP and the vaginal ring.

I am also looking forward to 2 studies that focus on the dapivirine vaginal ring, since there is a need for more options for long-acting PrEP modalities for cisgender women. 

One study will evaluate the pharmacokinetic profile of a 3-month dapivirine vaginal ring compared to a 1-month dapivirine vaginal ring. I am anxiously awaiting the results to see if this will be a more convenient and less wasteful option.

The other study will look at the results of dapivirine vaginal ring in pregnancy. These results are crucial because, even though women in the MTN-025/HOPE study were asked to use contraception, pregnancies did occur, indicating a need to understand the safety of the dapivirine vaginal ring in these situations.

Important results on the evaluation of potential pharmacologic interactions between other PrEP options (oral PrEP with TDF/FTC, and long-acting injectable cabotegravir) and hormone contraceptive agents will also be shown. This is a tertiary analysis from HPTN 084 amongst cisgender women in Africa. This analysis is very important so women can feel safe and protected from both unintended pregnancies and HIV infection.

Transgender Women
There are not many cohorts examining PrEP uptake in transgender women, but results from the ENCORE study group, an important multicenter cohort in the United States, will explore the continuum of biomedical prevention in transgender women.

The results from HPTN 091 will discuss PrEP uptake and adherence among transgender women in Brazil and in the United States. This study compares 2 different strategies: immediate vs deferred. Essentially, the immediate strategy is the offer of PrEP being colocated with gender-affirming hormone therapy plus peer health navigation sessions. The deferred strategy is gender-affirming hormone therapy being provided in a different place than where PrEP was provided.

The Future Is Now
Beyond these important clinical studies on long-acting PrEP options and the needs of transgender people and cisgender women, there will also be a wealth of information on other options. There will be detailed safety results of islatravir for prevention in cisgender women in Africa, men who have sex with men, and transgender women. There will also be exciting study results of broadly neutralizing antibodies.

As the HIVR4P conference unfolds, I encourage you to check the Clinical Care Options website for downloadable slides summarizing the data from these and other key studies. Also, plan to join me for live webinars as my colleague and I provide our take on the clinical implications of the data. After the meeting, look for more ClinicalThought commentaries featuring expert perspectives on integrating new data into practice around the world.

Your Thoughts?
What study are you most excited to see presented at HIVR4P this year? You can get involved with the discussion by posting a comment below.