Here's what the future of HIV treatment looks like

Image001 (1)Courtesy Johnson & JohnsonJohnson & Johnson chief scientific officer Paul Stoffels

A lot has happened in the 35 years since HIV/AIDS first made an appearance in the US.

Now medical advances have made HIV, especially if diagnosed early, a disease that can be controlled with medication. But there’s still a long way to go. In 2015 alone, 2.1 million people were newly diagnosed with HIV.

To catch up on what big pharma is up to at the 21st Annual AIDS Conference held this week in South Africa, Business Insider spoke with Johnson & Johnson’s chief scientific officer Paul Stoffels. The company is working on trials for an HIV vaccine, as well as a long-acting injectable form of HIV medication that could replace daily pills with a shot taken once every month or two months.

With all the advancements happening to turn HIV into a manageable disease, the shift in attention has been turning toward prevention efforts, which can help prevent people from contracting the virus in the first place. And although there are a number of programs in place to get people the prevention tools already available, it’s still not doing enough. Stoffels summed up the sentiment he’s felt at the conference: “A lot of work needs to be done,” he said. “Everyone here recognises that it’s not yet over.”

Here are the four things he suggested need to happen over the next four years.

1. Find ways to extend lives

“What needs to happen in the next five to 10 years is very carefully deploy the drugs we have to maximise life in the country,” he said. That way, people can stay on the medications for decades. And that’s going to take some work. The questions that need to be answered, he said, are, “How do we simplify therapy, and how do we make sure the supply gets simplified and you can get to the pills on a daily basis on fairly large scale.”

HIV infected T cell

Scanning electromicrograph of an HIV-infected T cell.

2. Keep a better eye on the amount of HIV in the blood

Having an undetectable viral load (which means the amount of HIV in the blood is so low it can’t be detected by a lab test) is important for quality of life. Making sure everyone has more frequent diagnostics to screen for this viral load, Stoffels suggested, would be one way to make that happen.

3. More research on new combinations and treatments

Right now, the typical course of treatment for HIV is daily pills, which can be hard to stick to. The combination of drugs, from J&J and ViiV Healthcare, is still going through clinical trials to show that it can work as an alternative to the daily pill.

“You first prove that in a certain way you can do it, and then you optimise on how you implement it,” Stoffels said. “With new formulations and the proof of concept is there, but it’s not yet practical to deploy this on a large scale.”

4. The possibility of an HIV vaccine to help with prevention

The HIV vaccine has been elusive over the past few decades, despite tons of research and money spent on the problem.

“We’re making vaccine research the highest priority of anything that we’re doing. More money is going towards [the vaccine] than any other component of HIV research” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told BuzzFeed News last year.

J&J is one of the companies working on a vaccine. On Tuesday, it announced that it had fully enrolled one phase 1/2a trial that recruited 400 volunteers from South Africa, Rwanda, Uganda, Thailand, and the US. The company on Tuesday also started enrolling a second phase 1/2a trial. The vaccine will be given as a series of injections over the course of a year. The goal of these earlier trials will be to figure out if the vaccine is safe, and if so, what’s the best way to administer the vaccine.

Right now, Stoffels said, it’s too early to predict what an HIV vaccine would look like: would it be just one set of shots you get at one point in your life, or if you’d need follow-up booster shorts later down the line.

“That would take more research, to figure out if years from now would we have to boost,” he said. “It’s not impossible, but at the moment, it’s too early to predict.”

A cure for HIV isn’t off the table

Stoffels said that he’s optimistic that a cure for HIV could be possible, albeit still incredibly far off.

“If we combine tools today and add some new science to that, can we get to ultimately cured patients?” he said. “It’s long way, it’s still a hope, but there are some early signs in the science that this might be a possibility.”

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