Driving Future Success with Current Investments in HIV Research International AIDS Society Members Meeting Paris, France July 26, 2017 Maureen M. Goodenow, Ph.D. NIH Associate Director for AIDS Research Director, Office of AIDS Research Vision for the Future

OAR Coordinates Trans-NIH HIV/AIDS Research Agenda Scientific, budgetary, legislative, and policy elements of NIH HIV/AIDS research Strategic plan as a roadmap for allocation of funds Allocates funding for HIV/AIDS research across NIH Ensures research dollars are invested in the highest priority areas of scientific opportunity for the global epidemic

OAR Coordinates Trans-NIH HIV/AIDS Research Agenda NICHD NINDS NIMH NIA OBSSR NINR NIDDK NIAAA NHLBI NIDA NIAID NCI NLM NIAMS NIMHD

Outcomes from HIV/AIDS Research Investments 1985 - 2000 2001 - 2015 2016 – 2030 HIV identified CD4 receptor NHP model Diagnostic test AZT approved HAART PMTCT bNAbs PrEP TaSP VMMC Efficacy signals for products Combination prevention Immune therapies Signal for rings 90/90/90 Long acting ARV U=U Controlled viral remission/ CURE Vaccine[s] New discoveries HIV/AIDS Research transformed biomedical research with the implementation of novel research frameworks: reference and reagent program, sequence data base, clinical trials networks with biorepositories……. 4

HIV/AIDS in 2017 In just 30 years: A previously fatal and much-feared disease is a treatable disorder with nearly normal life expectancy. More than half of the world’s 38 million PLWH receive ART. 5

HIV Across the Life Span Children Adolescents Youth Adults Seniors Neonates Infants Preteens 2 9 13 18 24 65 Age [yrs] Preventions Treatments Cure Vaccines Co-morbidities Co-infections

HIV/AIDS in 2017 Flat/declining resources persist No vaccine, no cure Increasing comorbidities and coinfections in PLWH 7

Overarching High Priority Areas for HIV/AIDS Research Reduce Incidence Next Generation Therapies Research Toward Cure Comorbidities & Coinfections Basic Research, Health Disparities, Training, Behavioral & Social Sciences

HIV Increases Risk for Co-morbidities Across the Life Span Cognitive disorders Cancer Osteoporosis Cardiovascular Frailty Depression Diabetes COPD Chronic LiverDisease renal disease TITLE: HIV INCREASES the RISK FOR DISEASES ASSOCIATED WITH AGING Many chronic conditions have been demonstrated to occur at higher rates in people with HIV on long term ART. Subtle immune compromise persists with treatment. Effects of HIV and aging may be synergistic. Opportunities for Trans NIH Partnerships

United States Epidemic: 2015 New HIV diagnosis across age groups 15-19 1698 8.0 20-24 7084 33.4 25-29 7510 31.2 30-39 9631 22.0 40-49 6720 15.0 50-59 4870 11.0 60+ 1855 6.1 TOTAL 39,513 12.3 Ages Nos Rate/100k Source: CDC Surveillance Report #27- 2015 >22% >17% Highest rate of new infections are in <30 age group with numbers increasing from 2010-2015 Targeted research agenda to identify, engage into care, and treat HIV infection in youth Treatment as prevention Develop strategies to address high rates of treatment failure among HIV+ youth

United States Epidemic: 2014 People living with HIV across age groups Youth 13-24 years: 5.8% of cases Individuals over >55 years: > 45% of cases Talking points Of the > 900,000 infected individuals only 6% are youth (CDC Surveillance Report #26-2014) In 2013, 26% of PLWH were 55 or older = 319,000 of the estimated 1.2 million people living with HIV. 42% of Americans living with diagnosed HIV were aged 50 and over. (https://www.cdc.gov/hiv/pdf/group/age/olderamericans/cdc-hiv-older-americans.pdf) Aging up population of infected individuals Research focus need be on interventions to treat and prevent co-morbidities (cardiovascular, metabolic, neurocognitive) Source: CDC Surveillance Report #26- 2014

HIV Infection Increases Over Time in Older Age Groups in U.S. 2013 (Observed) 2025 (Projected) 2045 (Projected) 65+ 55 – 64 45-54 35-44 25-34 <25 65+ 55 – 64 45-54 35-44 25-34 <25 65+ 55 – 64 45-54 35-44 25-34 <25 200 100 100 200 200 100 100 200 200 100 100 200 Population in thousands Male Females Hood et al. AIDS Care 2017; Epub. ©2017, Johns Hopkins University. All rights reserved.

HIV Care Continuum Across the Life Span: Linkage, Retention, and Viral Suppression Remain Low 55 and over Estimate * 100 Diagnosed Linked to care Retained in Care Virally suppressed 45-54 80 35-44 25-34 13-24 60 % 40 20 CDC 2013

OAR To advance research that impacts health outcomes of the HIV epidemic

OAR Action Plan for the Future Align the Research with the Epidemic Expand Partnerships with Community Continue the Momentum in Prevention Vaccines PrEP Behavior and Social Sciences Reduce Complications of HIV Infection Promote Urgency to Change the Status Quo Be Prepared for Unexpected Discovery! We encourage our partners to build collaborations and new infrastructures in order to move in new directions to include more pediatric and aging populations, ethnic and racial groups which are disproportionately affected by the epidemic, and women and girls in your research trials.

Research Leads to Sound Health Policy Data Policy Research yields data which becomes the basis for programs, practices and policies. Our decisions and actions over the next three to five years will set the path to 2030. Looking to Clinical Trials Networks to generate the data that will provide foundation for sound health policy. What we decide now sets the path to 2030

NIH… Turning Discovery Into Health 17