 Biomedical HIV Prevention strategies Wim Vandevelde European AIDS Treatment Group (EATG) European Community Advisory Board (ECAB) Conference on HIV Infection among Hidden Groups (MSM and CSW) IHMT/UNL, March 28 th 2011, Lisboa

EATG Mission  to achieve the fastest possible access to state-of-the-art medical products, devices and diagnostic tests, which prevent or treat HIV infection, or improve the quality of life of people living with HIV.

ECAB objectives advise the research community on the needs of the local community and the appropriateness of proposed HIV research advise the PLHIV community on the aims and expectations of research proposals and the appropriateness of the research

Biomedical HIV prevention strategies  Vaccines  Oral PrEP and PEP  ARV-based topical vaginal and rectal microbicides  Treatment as Prevention

Effective prevention strategies for MSM and CSW are  comprehensive and complementary  evidence-based  based on Human Rights principles  without moralistic or judgmental attitudes  designed to include and empower target populations  community-based and peer-to-peer

HIV Vaccine  potentially the ideal “magic bullet” for prevention  challenges for uptake/access for adequate population coverage  unlikely 100% effective => complementary tool  Merck STEP trial  Thailand study with ALVAC/AIDSVAX combination

Microbicides  antimicrobial agents unsuccessful so far (eg. Nonoxynal-9)  promising ARV-based topical vaginal/rectal microbicides  CAPRISA 004 study in South Africa (vaginal gel, TDF)  CROI 2011: MTN 006 study (rectal gel, TDF)  challenges: adherence requirements, drug resistance?, less than 100% efficacy  great potential for MSM and CSW

ARV treatment as prevention  suppressed viral load => reduced infectiousness  ART = effective component of a multilevel prevention effort  adherence is critical  lower vigilance for protective behaviors?  barriers to access for hard-to-reach populations

Pre- and Post-Exposture Prophylaxis  PEP: occupational AND non-occupational  Long-term side effects and resistance?  PrEP with TDF/FTC, maraviroc, raltegravir, …  PrEP target populations? High-risk MSM?  iPrEx study with TDF/FTC (MSM): 44%-90% effective  Who will pay/reimburse for PrEP? Differential pricing?  PEP does not necessarily lead to an increase in high-risk behavior

Acknowledgements  Mary Jane Rotheram-Borus, Dallas Swendeman (Semel Institute for Neuroscience and Human Behavior, University of California)  Gary Chovnick (Department of Health Services, School of Public Health, University of California)  Luís Mendão (EATG/GAT) Thank You!