1. 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

2. 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

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

4. Outcomes from HIV/AIDS Research Investments
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

5. 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

6. 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

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

8. 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

9. 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

10. United States Epidemic: 2015 New HIV diagnosis across age groups
TOTAL ,
Ages Nos Rate/100k
Source: CDC Surveillance Report #
>22%
>17%
Highest rate of new infections are in <30 age group with numbers increasing from
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

11. United States Epidemic: 2014 People living with HIV across age groups
Youth 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 # )
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. (
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 #

12. 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.

13. 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

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

15. 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.

16. 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

17. NIH…
Turning Discovery Into Health 17