amfAR Think Tanks: A Blueprint for Action Against HIV/AIDS
By Rowena Johnston, Ph.D., and Jeffrey Laurence, M.D.
September 16, 2008—amfAR will gather HIV experts at the end of September for three think tanks that will tackle the complexities of circumcision, the possibility of a cure for AIDS, and the need for a global social/behavioral research network.
At the first think tank, Foreskin Keratinization: Alternative to Male Circumcision in the Prevention of HIV Transmission?, which will be held September 19-21, discussion will revolve around the role of adult male circumcision in HIV prevention. In recent years, three trials conducted in Africa found that men who underwent circumcision experienced a reduction of up to 60 percent in their risk of acquiring HIV via penile-vaginal intercourse. But surgical complications, costs, and a dearth of local expertise in this surgery constitute critical potential impediments to the widespread roll-out of adult male circumcision.
Is there an alternative? Could a chemical applied to the foreskin mimic the protective effect of its removal? This think tank will address a range of alternatives to surgical circumcision.
What if infection has already occurred? It is unlikely that we will ever be able to treat our way out of this pandemic, but will AIDS ever be cured—the virus eliminated from the body and the immune system restored? These will be issues for the second think tank, Approach to Curing AIDS, which will take place September 26-28.
A test tube of immune cells infected with HIV can be “cured” though gene therapy approaches. How might test-tube successes be replicated to reach all HIV-infected cells in an infected person? According to a report from a single patient in Berlin, presented at the Conference on Retroviruses and Opportunistic Infections held this year in Boston, this feat may already have been accomplished by using a bone marrow transplant approach similar to that used to treat leukemia.
A 40-year-old HIV-positive man with leukemia received a transplant from a donor who had a genetic condition known as delta32-CCR5, a mutation that renders the person’s immune cells resistant to infection by most types of HIV. The transplant was a success, with the patient’s leukemia in complete remission. The patient has also remained off all his anti-HIV drugs for more than a year, yet there is no detectable HIV in his body. Has he been cured? Can this success be replicated in another patient? Is more research necessary before another human experiment is suggested? This think tank will address these and other related questions.
Social and behavioral research will be the focus of another think tank, to be held September 23-24. Recognizing that social and behavioral factors are inextricably woven into the responses of individuals, groups, and governments to the challenges posed by HIV, this meeting will explore the need for establishing an international social/behavioral research network. Every region of the world, and the various groups within those regions, experiences its own mix of stigma, mistrust, lack of awareness, and cultural, economic, and sociopolitical forces that influence the efficacy of prevention or treatment interventions.
This think tank will address key questions such as, to what extent are experiences in these different contexts similar or different? Will solutions that work in one region of the world, or in one population, be applicable across diverse regions or populations? Would a carefully defined research network involving vulnerable populations in different regions provide new answers to these centrally important questions?
What will amfAR’s next steps be? How do we seize the moment to convert challenges into opportunities? Think tanks like these begin to shape answers and a blueprint for action.
Dr. Laurence is amfAR’s senior scientific consultant. Dr. Johnston is amfAR’s vice president of research.