Interview: Co-Chair Mitchell Warren

You have described this as a golden age in HIV prevention. What makes you excited about this moment in the HIV response? 

When you look back on the 40 year trajectory of the HIV pandemic, I’m amazed at the momentum that HIV prevention research has had throughout 2020, even in the midst of COVID-19. The year started with very disappointing news from HVTN 702 showing that that vaccine didnt work. But since then, we’ve had the initial results from longacting Cabotegravir (CABLA) showing terrific benefit, at least in a couple of populations. And shortly thereafter the positive opinion on the dapivirine vaginal ring, which is both a woman initiated method and the first regulatory opinion on a long acting prevention tool. We have the Mosaico vaccine trial, the largest phase three trial in years, underway in multiple countries. Very soon we will have results from the AMP studies of antibody-mediated prevention. And we are generating entirely new insights, even from the disappointing results of 702, into what we do need to do for vaccines. In all, we have more safe and effective prevention options available and in development than ever before.  

I’ve never seen so much momentum around so many different prevention modalities.  

What we do with all of those data, though, presents some hugely important unanswered questions.  

 

What are some of those challenges ahead? 

Like any good study, every one of the trial results in the last seven month answers a question and raises a host of new ones. For example, what is the best approach to an HIV vaccine? It clearly wasn’t ALVAC in the 702 trial. But understanding what those results mean and the implications for the next generation of trials is crucial. The AMP results will open new questions, about which antibodies and what antibody responses are most important, and whether we can get that response in a vaccine. 

When you look further downstream, we have this positive opinion on the dapivirine ring. But how do we make a moderately effective, women controlled method available as an additional choice? How do we translate even the partial efficacy seen in trials into public health impact? How do we deliver a vaginal ring in eastern and southern Africa, where vaginal rings have never been available? 

We know that cabotegravir injected every two months is safe and effective for men who have sex with men, and transgender women. We don’t know if it works in cisgender women, and we’re waiting for HPTN 084 to tell us that. Similarly, late last year we got approval of F-TAF for oral prep for some, but not all people, because the trial was never done in cisgender women. So there are huge question marks about how these products might work differently for different people. 

For me, one of the biggest challenges is how we can remove the siloes around these different products and get to a new way of talking about prevention. I think a lot about the difference between options and choices. Seemingly every month or so presents the prospect of new prevention options, with rings, new oral formulations, an injectable. But those only become choices if we act as a global community to set up the policies, programs and funding mechanisms to make those true choices for individuals.  

That’s why HIVR4P is so important. We really are a conference that works to bridge the gaps between developing new prevention options and understanding how we make those viable choices for the individual. And that’s the work we need to accelerate. 

 

Has COVID-19 changed your perspective on how the HIV prevention field should move forward? 

COVID-19 has influenced everything we do. I don’t think anyone in global health, in HIV or infectious diseases, isn’t also working on COVID-19 now.  

Two things really jump out for me. One, how do we make sure that even as we rightly pivot to focus on COVID-19, we don’t lose the amazing gains made in HIV, toward the 909090 targets, in the development of new technologies and prevention options? A couple years ago, we started talking about the tipping point in HIVthat if we could get to the point of having fewer new infections than people dying of AIDS, we would tip toward ending the epidemic. One can also tip back, however. And COVID-19 presents this huge challenge of how do we not only respond to COVID-19 with science, with evidence, with HIV lessons in our head, but how do we make sure that we don’t lose sight of the gains made in the HIV response, in TB and in related global health issues? 

We’ve got to figure out what this new global health architecture looks like for funders, for policymakers, for science and researchers. How do we do respond to the newest pandemic without losing sight of the essential importance of a focus on decadesold pandemics? 

 

We’re entering an era of virtual scientific conferences. What are the major opportunities and challenges for HIVR4P // Virtual? 

For all the work we all do in putting together robust invited speaker sessions, or really remarkable abstract sessions, perhaps the best part of HIVR4P is what happens outside the session room. The kind of dynamism that happens in the hallway, when people are sharing enthusiasm for what they just heard, or new insights or ideas that spark a whole new collaboration.  

I am very confident that we can deliver a great scientific program, because there is great science in HIVR4P. We’ve also got to figure out how to enable more human interaction in virtual settings. Sparking new ideas and new collaborations has always been an important part of HIVR4P. How you get advocates and researchers asking each other questions about their experiences and perspectives.  

One of our biggest opportunities is that, while each of those previous HIVR4P conferences could only bring together 1200 to 1400 people, we have an opportunity to make HIVR4P // Virtual a global conversation that engages thousands of people in real time.  

That’s a great opportunityto be able to look back at HIVR4P // Virtual and say that the conference fed conversations around the world. That’s going to come down to all of us using not just the conference platform but also text messages, WhatsApp groups, emails and chat features. We need to make sure that everyone is talking and taking HIV prevention to a new level.  

 

What are you most excited about learning at the conference? 

I’m most excited about understanding what we do with everything we’ve learned in the last few months, and what we’ll learn in the months ahead. We have all of these study results…what will we do as a global community to make those come alive? How do we make the AMP result relevant to vaccine developers and other antibody researchers? How do we make the cabotegravir result matter for women and men around the world? HIVR4P // Virtual can be a milestone in translating the most exciting, most diverse prevention science into the most exciting and diverse prevention programs of the future. That’s my top question for this meeting…how do we turn those options into choices, and how do we make those choices real?