2023: Milestones, Roadblocks, and the Path Ahead

No year-end roundup can hope to be complete, particularly in the case of a subject as complex and multifaceted as HIV/AIDS. Below I have tried to touch on the most important advances—including some of amfAR’s many recent achievements—and setbacks of the past year, which collectively will inform the shape of things to come in the year ahead.

Throughout the course of the epidemic, success has been dictated by favorable public policies as much as by scientific breakthroughs. That’s why our advocacy program is every bit as impactful as our research initiatives. There’s reason to fear that the policy headwinds we have faced in 2023 may develop into storm clouds that could severely disrupt the domestic and global AIDS responses in 2024 and beyond. We remain hopeful, however, and resolute in our pursuit of a cure and an end, finally, to the global HIV/AIDS epidemic.

THE GOOD

New case of a cure? — In July, it was reported that a man in his early fifties may have been cured of HIV, once again through a stem cell transplant. If confirmed, the “Geneva patient” would be the sixth person known to have been cured to date. Dr. Asier Sáez-Cirión, of the Pasteur Institute in Paris and a member of amfAR’s ICISTEM research consortium, presented the findings.

Post-treatment control — Researchers in the Netherlands shared study results detailing a new case of post-treatment control of HIV. Analyses by investigators including past amfAR grantee Dr. Jori Symons of University Medical Center Utrecht, suggest that this may have been caused by strong CD8 immune responses and a virus that seems slow to replicate, possibly due to a mutation.

Nobel Prize — Along with collaborator Dr. Katalin Karikó, veteran HIV vaccine researcher and amfAR grantee Dr. Drew Weissman of the University of Pennsylvania was awarded the 2023 Nobel Prize in Physiology or Medicine for his work on mRNA, which proved instrumental in the development of effective vaccines for Covid-19. The technology could have applications for a wide range of diseases and conditions, including HIV.

$5.5 million in research awards — amfAR awarded new grants to research teams in the U.S. and Europe pursuing a cure for HIV.

amfAR cure trial – The results of a clinical trial conducted by researchers at the amfAR Institute for HIV Cure Research were announced in February. The trial established proof of concept that combination immunotherapy may induce post-treatment control of HIV by altering facets of the virus or the immune response to it.

Blood donations — On the policy side, the Food and Drug Administration in May officially changed its policy on blood donations, allowing gay and bisexual men to donate blood based on screening questions that focus on individual risk rather than blanket restrictions.

“A” grade for long-acting PrEP — The U.S. Prevention Services Task Force issued a long-awaited statement on PrEP, awarding an “A” grade for both pills and long-acting injectables. The statement said, in part: “PrEP is a safe, highly effective way to help prevent HIV in people who do not have HIV but are at increased risk of getting it.” 

THE NOT SO GOOD

Fight over PEPFAR — Perhaps the single most troubling development of 2023, with potentially catastrophic consequences for the global HIV/AIDS response, was the fight in Congress over the reauthorization of PEPFAR. Arguably the most successful global health program in history, continued funding for PEPFAR—which has enjoyed solid bipartisan support for the past 20 years—has been sacrificed on the altar of abortion politics. Its future is now unclear.

Threat to domestic funding — A draft appropriations bill introduced to the House of Representatives in September would cut domestic funding for HIV programs by around half a billion dollars, eliminating funding for the Ending the HIV Epidemic initiative and slashing federal support for HIV prevention, treatment, and research. The bill remains in limbo.

Vaccine trial fails — Investigators in December announced that the PrEPVacc HIV vaccine trial had been shut down as it had failed to demonstrate efficacy. The study was testing two different vaccine candidates on 1,500 participants in East and Southern Africa. Researchers had described the trial as the last chance to develop an HIV vaccine this decade since no other candidate is close to human trials.

Tennessee rejects HIV funds — The year began with the abrupt rejection by the state of Tennessee of federal funding for HIV services. Officials said they wanted to focus on those deemed most at risk of infection such as first responders, mothers and children, and victims of human trafficking—groups at very low risk of HIV. Leading public condemnation of the decision, amfAR estimated it could cost the state more than $250M in additional treatment costs per year.

Ruling on PrEP coverage — In March, a federal judge struck down a provision of the Affordable Care Act requiring health insurance companies to cover preventive care services such as screenings for cancer, depression, diabetes—and PrEP. The plaintiffs in the case argued that mandating coverage for birth control, PrEP, and HIV screening violated the constitutional right to religious freedom. 

THE YEAR AHEAD

Funding fights — The battles over federal funding for domestic and global HIV programs will continue, and amfAR will do everything in its power to ensure that our gains against HIV over the past 20 years are not for nothing. Like the virus itself when treatment is stopped, we know from past experience how HIV can rebound with a vengeance when critical investments are cut.

AIDS 2024 —The 25^th International AIDS Conference will take place in Germany in July. Featured speakers include amfAR grantee Dr. Melanie Ott of the University of San Francisco, California, and Dr. Jeanne Marrazzo, successor to Dr. Anthony Fauci at the National Institute of Allergy and Infectious Diseases.

New research — It is too soon to predict what findings will be announced in 2024, but we expect to see, for example, more data from trials such as Excision BioTherapeutics EBT-101, the much-touted first-in-humans experimental gene therapy that aims to cut out large portions of the HIV genome.

Event anniversaries — We eagerly anticipate the 30^th annual amfAR Cannes benefit gala in May 2024 and 25^th TWO x TWO for AIDS and Art in Dallas in October. Our most successful international and U.S. events, respectively, the two galas have collectively raised more than $300 million for amfAR’s AIDS research programs to date.

U.S. election — The outcome of the 2024 election could determine the course of the fight against AIDS, in the U.S. and around the world, for the foreseeable future. At stake in this election is the survival of Obamacare, the U.S. commitment to fighting AIDS globally, the undoing of years of progress on domestic HIV, further attacks on LGBTQ and reproductive rights, and the slashing of federal funding for HIV research.

It promises to be a turbulent year.

Kevin Robert Frost is amfAR’s chief executive officer.