As the 2022 virtual Conference on Retroviruses and Opportunistic Infections (CROI 2022) came to a close, NIH’s Dr. Carl Dieffenbach joined HIV.gov for a video conversation on February 24 to discuss important findings on cancer prevention in people with HIV, research on HIV and aging, and the future of HIV prevention and treatment. Dr. Dieffenbach is the Director of the Division of AIDS at NIH’s National Institute of Allergy and Infectious Diseases (NIAID). Watch the conversation with Dr. Dieffenbach:
Here are some highlights from Dr. Dieffenbach’s conversation with HIV.gov:
Anal Cancer Prevention for People with HIV
Dr. Dieffenbach first discussed findings from the ANCHOR study, a large-scale study to investigate whether screening people with HIV for precancerous growths in the anus called high-grade squamous interepithelial lesions (HSIL) and treating them early can prevent anal cancer. Researchers have known for many years that screening and treating HSIL in the cervix can successfully prevent cervical cancer, but they did not know whether similar methods could help prevent anal cancer. While anal cancer is rare, people with HIV are much more likely to develop it than the general population.
In the Anal Cancer/HSIL Outcomes Research (ANCHOR) study, presented at CROI by Dr. Joel Palefsky of the University of California San Francisco, more than 10,000 people with HIV over the age of 35 were screened for HSIL at 25 U.S. sites. Of 4,446 participants found to have HSIL, half were randomly assigned to receive treatment and half to receive active monitoring, but no treatment. The researchers found that treatment of HSIL, primarily with office-based electrocautery in which an electric current was targeted directly to areas of the HSIL to remove them, led to a significant reduction in anal cancer incidence and was well-tolerated. Further, anal cancer incidence was higher than expected among ANCHOR study participants who did not receive treatment. Dr. Dieffenbach observed that these study findings suggest that routine screening for and early treatment of anal HSIL may become a new standard of care for people with HIV so that more cases of anal cancer can be prevented. He also noted the importance of training more healthcare providers to conduct anal HSIL screening and treatment so there is sufficient capacity to do the procedures. The ANCHOR study was supported by NIH’s National Cancer Institute. Jump directly to this part of the conversation in the video. View the ANCHOR Study abstract on the CROI website.
HIV and Aging
Aging and HIV was a cross-cutting theme of this year’s CROI. As Dr. Dieffenbach explained, this large and growing area of HIV research is the result of highly effective antiretroviral therapy (ART) that has enabled many people with HIV to live long lives. Researchers are now examining what it means to age with HIV and how the consequences of the virus, ART, or both affect the overall health of people with HIV. Scientists are also investigating which interventions effectively prevent or reduce the comorbidities, cancers, and other consequences of the long-term immune activation and inflammation caused by living with HIV for many years. One example of such research that Dr. Dieffenbach pointed to is the NIH-supported REPRIEVE clinical trial, which is studying whether a statin medication could help reduce heart disease among people with HIV.
Findings from research related to aging with HIV must move into practice in health care and other settings, Dr. Dieffenbach observed. He highlighted one way this is happening: recent funding opportunities from HRSA to support Ryan White HIV/AIDS Program sites to identify, refine, evaluate, and disseminate emerging strategies to comprehensively screen and manage comorbidities, geriatric conditions, behavioral health, and psychosocial concerns of people ages 50 years and older with HIV. He also highlighted that the new National HIV/AIDS Strategy focuses on engaging both federal and nonfederal partners in multisectoral approaches to support healthy aging with HIV. Jump directly to this discussion in the video.
Future HIV Prevention and Treatment Options
Dr. Dieffenbach then discussed the future of HIV prevention and treatment, which he characterized as “a very active area of research” as evidenced by numerous presentations at the conference. An overarching goal of all the research, he explained, is to make medication adherence as easy as possible, thereby increasing the chances that the HIV treatment or prevention strategy will be successful. One way to foster adherence that researchers are investigating is long-acting or sustained-release drug formulations that easily and safely increase the time between doses. Among the options being studied are a once-weekly pill, as well as long-acting injections and sustained-release implants that provide coverage for a month or more. (Dr. Dieffenbach discussed the latest findings on the one FDA-approved long-acting injectable form of PrEP in a video conversation last week.) Ultimately, Dr. Dieffenbach explained, the hope is to have a suite of choices available for people who need either HIV prevention or HIV treatment so each person can choose the option that works best them. Jump directly to the discussion of this topic in the video.
CROI is an annual scientific meeting that brings together top researchers from around the world to present and discuss the latest studies that can help accelerate global progress in the response to HIV/AIDS and other infectious diseases, including COVID-19. More than 3,000 HIV and infectious disease researchers gathered virtually this year over two weeks for this forum. Among the studies presented were many that had been conducted or supported by NIH and CDC.