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Dubé K, Perez-Brumer A, Patel H, Zhou C, Dee L, Graham G, Meanley S, Philbin MM. "This Is Actually a Really Unique Moment in Time": Navigating Long-Acting HIV Treatment and HIV Cure Research with Analytical Treatment Interruptions-A Qualitative Interview Study in the United States. AIDS Res Hum Retroviruses 2024. [PMID: 38386494 DOI: 10.1089/aid.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Advancements in long-acting (LA) HIV treatment and cure research with analytical treatment interruptions (ATIs) have generated important scientific and implementation questions. There is an urgent need to examine challenges navigating the evolving HIV treatment and cure research landscape. From August to October 2022, we conducted 26 semistructured interviews with biomedical researchers and community members representing a predominantly woman demographic to explore the complexity of navigating the rapidly evolving HIV therapeutic and HIV cure research landscape. We purposively sampled individuals recruited from the AIDS Clinical Trials Group and the Martin Delaney Collaboratories for HIV Cure Research. Audio files were transcribed verbatim and analyzed through a thematic approach, using an inductive and iterative process. Among 26 participants, 10 were biomedical researchers and 16 community members, including 11 were people with HIV. Three main themes emerged: (1) We are at a pivotal moment in the evolving landscape of HIV therapeutics and LA HIV treatment and HIV cure research should not be siloed but considered together; (2) There are challenges with engagement in HIV cure research and in switching between oral daily antiretroviral treatment and LA formulations and, mainly, the prolonged pharmacokinetic tail of these compounds matched with limited patient education about their impacts; and (3) There are unique opportunities as a result of this evolving therapeutic landscape, including the key role of decision support for people with HIV, centering around patient autonomy, and the need to learn from the lived experiences of people with HIV who choose LA treatment and/or participation in HIV cure research. Despite a bias toward the woman gender, our study identifies key considerations for navigating concurrent LA HIV treatment and HIV cure research with ATIs from both community members and biomedical researchers' perspectives. Achieving optimal HIV control remains a formidable challenge, necessitating robust interdisciplinary collaborations and engagement with key stakeholders.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Carina Zhou
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, Maryland, USA
| | - Gail Graham
- PATIENTS Program, University of Maryland, College Park, Maryland, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Morgan Mari Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Dubé K, Ndukwe SO, Korolkova A, Dee L, Sugarman J, Sauceda JA. Participant experiences in a combination HIV cure-related trial with extended analytical treatment interruption in San Francisco, United States. HIV Res Clin Pract 2024; 25:2312318. [PMID: 38348830 PMCID: PMC10951555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is limited systematic information available about the perspectives of participants enrolled in intensive combination HIV cure-related trials inclusive of an extended analytical treatment interruption (ATI). OBJECTIVE To assess and understand experiences of people with HIV involved in a combination HIV cure-related trial with an extended ATI. METHODS The trial included five interventions and was followed by an ATI lasting up to 52 wk. From 2022 - 2023, we conducted in-depth interviews with study participants following their extended ATIs. Interviews were audio-recorded, transcribed, and analyzed via conventional thematic analysis. RESULTS We interviewed seven participants. The majority were male, White, and non-Hispanic, with a median age of 37 years. Trust in the research team, scientific altruism and hope of becoming a post-intervention controller were key motivators for joining the trial. Interviewees reported being satisfied with their decision to participate in the trial and the extended ATI. Most recounted feelings of worry related to viral rebound during the ATI. Participants reported both defeat and relief with ART restart. Four faced challenges with protecting partners from HIV during their ATI, such as trying to find out if their partner(s) were using pre-exposure prophylaxis. CONCLUSIONS Our findings demonstrate potential improvements for future ATI trial participant experiences, such as more robust resources for psychosocial support and partner protections. Dedicating greater effort to understanding participant ATI experiences can inform the design of future participant-centered HIV cure trial protocols.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
- Gillings School of Global Public Health, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
| | - Ana Korolkova
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA
- Delaney AIDS Research Enterprise (DARE) Community
Engagement Coordinator, San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore,
MD, USA
| | - John A. Sauceda
- Division of Prevention Science, Center for AIDS Prevention
Studies (CAPS), San Francisco, CA, USA
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Noorman MAJ, de Wit JBF, Marcos TA, Stutterheim SE, Jonas KJ, den Daas C. The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives. AIDS Behav 2023; 27:3789-3812. [PMID: 37329470 PMCID: PMC10589186 DOI: 10.1007/s10461-023-04095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
As research into the development of an HIV cure gains prominence, assessing the perspectives of stakeholders becomes imperative. It empowers stakeholders to determine priorities and influence research processes. We conducted a systematic review of the empirical literature on stakeholder perspectives. PubMed, Embase, Web of Science, and Scopus were searched for empirical, peer-reviewed articles, published before September 2022. Our analysis of 78 papers showed that stakeholders could be divided into three categories: people with HIV, key populations, and professionals. Following thematic synthesis, two main themes were distinguished: stakeholders' perspectives on HIV cure research and stakeholders' perspectives on HIV cure. Research on perspectives on HIV cure research showed that stakeholders' hypothetical willingness to participate (WTP) in HIV cure research was relatively high, while actual WTP was found to be lower. Studies also identified associated (individual) characteristics of hypothetical WTP, as well as facilitators and barriers to hypothetical participation. Additionally, we reported research on experiences of actual HIV cure research participation. Our analysis of stakeholder perceptions of HIV cure showed that most stakeholders preferred a cure that could eliminate HIV and outlined positive associated impacts. Furthermore, we observed that most included studies were conducted among PWHIV, and in the Global North. To empower stakeholders, we recommend that future research include an even greater diversity of stakeholders and incorporate theories of behavior to further explore how stakeholders decide to meaningfully engage in every stage of HIV cure research.
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Affiliation(s)
- Maaike A J Noorman
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Tamika A Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Chantal den Daas
- Institute of Applied Health Sciences, Health Psychology Group, University of Aberdeen, Aberdeen, UK
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Bilger A, Plenn E, Barg FK, Rendle KA, Carter WB, Lamour-Harrington A, Jones N, Peterson B, Sauceda JA, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dubé K. Participant experiences in HIV cure-directed trial with an extended analytical treatment interruption in Philadelphia, United States. HIV Res Clin Pract 2023; 24:2267825. [PMID: 37837376 PMCID: PMC10634456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND A feature of HIV cure trials is the need to interrupt treatment to test the efficacy of experimental interventions-a process known as analytical treatment interruptions (ATIs). OBJECTIVES We report the experiences of participants after they completed an extended ATI. METHODS From April to November 2022, we conducted post-ATI in-depth interviews with BEAT2 clinical trial (NCT03588715) participants who stopped ART while receiving an immunotherapy regimen. We used conventional content analysis to code the data. RESULTS We conducted interviews with 11 Black/African American and three White/Caucasian participants (11 males, two females, and one transgender woman). The mean ATI was 38 weeks. Participants noted several significant experiences surrounding the interventions' side effects, ATI, and returning to medication. Some participants had positive experiences with their ATI. Other participants were nervous during the ATI. Rising viral loads led some to feel a sense of failure. Although trial experiences were heterogeneous, participants unanimously had positive interactions with the clinical trial staff which facilitated their retention in the trial. Participants shared their experiences with the trial, including changes in expectations, experiences with experimental interventions and procedures, compensation as a measure of respect, effort, transportation, and effects of COVID-19 during the trial. Based on these results, we provide considerations for the conduct of future HIV cure-directed clinical trials involving ATIs. CONCLUSIONS Managing expectations, focusing on participants' contributions, and providing support to reduce feelings of having failed the research team and/or the HIV community following viral rebound should be part of HIV cure trial design. Discussing the mental health impact of rebound during consent, distinct from risk, is needed. Continued efforts to understand how people with HIV experience ATIs will improve future designs of HIV cure clinical trials.
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Affiliation(s)
- Andrea Bilger
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Eion Plenn
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Frances K. Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - William B. Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - Nora Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - John A. Sauceda
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA
| | - Pablo Tebas
- Hospital of the University of Philadelphia, University of Pennsylvania, Pennsylvania, PA, USA
| | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | | | - Karine Dubé
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dubé K, Morton T, Fox L, Dee L, Palm D, Villa TJ, Freshwater W, Taylor J, Graham G, Carter WB, Sauceda JA, Peluso MJ, Rid A. A partner protection package for HIV cure-related trials involving analytical treatment interruptions. THE LANCET. INFECTIOUS DISEASES 2023; 23:e418-e430. [PMID: 37295453 PMCID: PMC10543569 DOI: 10.1016/s1473-3099(23)00267-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Analytical treatment interruptions (ATIs) have become a key methodological approach to evaluate the effects of experimental HIV cure-related research interventions. During ATIs, sex partners of trial participants might be at risk of acquiring HIV. This risk raises both ethical and feasibility concerns about ATI trials. We propose a partner protection package (P3) approach to address these concerns. A P3 approach would provide guidance to investigators, sponsors, and those who are designing and implementing context-specific partner protections in HIV cure-related trials involving ATIs. The approach would also help assure institutional review boards, trial participants, and communities that ATI trials with a P3 would provide appropriate partner protections. We offer a prototype P3 framework that delineates three basic considerations for protecting participants' sex partners during ATI trials: (1) ensuring the scientific and social value of the ATI and the trial, (2) reducing the likelihood of unintended HIV transmission, and (3) ensuring prompt management of any acquired HIV infection. We outline possible ways of implementing these basic considerations.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA; University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Tia Morton
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lawrence Fox
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lynda Dee
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; AIDS Action Baltimore, Baltimore, MD, USA
| | - David Palm
- AIDS Clinical Trials Group Global Community Advisory Board, Chapel Hill, NC, USA; Institute of Global Health and Infectious Diseases Clinical Trials Unit, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas J Villa
- HIV Obstruction by Programmed Epigenetics Delaney Collaboratory Community Advisory Board, Gladstone Institutes, San Francisco, CA, USA; National HIV & Aging Advocacy Network, National Minority AIDS Council, Washington, DC, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Rockville, MD, USA
| | | | - Jeff Taylor
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Palm Springs, CA, USA; HIV + Aging Research Project, Palm Springs, CA, USA
| | | | - William B Carter
- Baltimore, MD, USA; BEAT-HIV Collaboratory Delaney Community Advisory Board, Wistar Institute, Philadelphia, PA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies, Division of Prevention Sciences, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Peluso
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Annette Rid
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
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Dubé K, Mthimkhulu D, Ngcobo W, Mindry D, Maphalala L, Pillay V, Tran W, Korolkova A, Ndung’u T, Dong K. 'With this study, we have hope that something is coming': community members' perceptions of HIV cure-related research in Durban, South Africa - a qualitative focus group study. HIV Res Clin Pract 2023; 24:2243046. [PMID: 37555592 PMCID: PMC10433450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Developing a cure for HIV remains a global scientific priority. In 2022, the Females Rising through Education, Support and Health (FRESH) cohort launched an HIV cure-related trial involving an analytical treatment interruption (ATI) in Durban, South Africa. OBJECTIVES To explore community perspectives about HIV cure-related research. METHODS Between July-August 2022, we conducted three focus groups with community members. We transcribed audio recordings verbatim and used content analysis to analyze the data. RESULTS Twenty community members (13 women and 7 men) participated in three focus groups (HIV status not included). Participants viewed HIV cure-related research as a way to address the issue of defaulting on (not taking) HIV treatment. Participants expressed hesitancy around ATIs, since these contradict longstanding treatment adherence messages. Participants shared concerns around the risk of side effects from experimental interventions balanced against potential efficacy. They advocated for trial participants to have the right to decide whether to inform their sex partners about their HIV status and ATI participation, rather than research teams making disclosure mandatory. Focus group participants also emphasized the importance of using simple language to explain HIV cure-related research. CONCLUSIONS With HIV cure trials set to launch across Africa in the future, there is a critical need to better understand and respond to local community needs and preferences and to adopt this as standard practice prior to regional trial implementation.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Deli Mthimkhulu
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Wiseman Ngcobo
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Deborah Mindry
- Center for Gender and Health Justice, University of California Global Health Institute, Los Angeles, CA, USA
| | - Luyanda Maphalala
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Vanessa Pillay
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Whitney Tran
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Ana Korolkova
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal (UKZN), Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Krista Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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Dubé K, Peterson B, Jones NL, Onorato A, Carter WB, Dannaway C, Johnson S, Hayes R, Hill M, Maddox R, Riley JL, Shull J, Metzger D, Montaner LJ. Community engagement group model in basic and biomedical research: lessons learned from the BEAT-HIV Delaney Collaboratory towards an HIV-1 cure. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:39. [PMID: 37291622 DOI: 10.1186/s40900-023-00449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Achieving effective community engagement has been an objective of U.S. National Institutes of Health-funded HIV research efforts, including participation of persons with HIV. Community Advisory Boards (CABs) have remained the predominant model for community engagement since their creation in 1989. As HIV cure-directed research efforts have grown into larger academic-industry partnerships directing resources toward both basic and clinical research under the Martin Delaney Collaboratories (MDC), community input models have also evolved. The BEAT-HIV MDC Collaboratory, based at The Wistar Institute in Philadelphia, United States, implemented a three-part model for community engagement that has shown success in providing greater impact for community engagement across basic, biomedical, and social sciences research efforts. DISCUSSION In this paper, we review the case study of the formation of the BEAT-HIV Community Engagement Group (CEG) model, starting with the historical partnership between The Wistar Institute as a basic research center and Philadelphia FIGHT as a not-for-profit community-based organization (CBO), and culminating with the growth of community engagement under the BEAT-HIV MDC. Second, we present the impact of a cooperative structure including a Community Advisory Board (CAB), CBO, and researchers through the BEAT-HIV CEG model, and highlight collaborative projects that demonstrate the potential strengths, challenges, and opportunities of this model. We also describe challenges and future opportunities for the use of the CEG model. CONCLUSIONS Our CEG model integrating a CBO, CAB and scientists could help move us towards the goal of effective, equitable and ethical engagement in HIV cure-directed research. In sharing our lessons learned, challenges and growing pains, we contribute to the science of community engagement into biomedical research efforts with an emphasis on HIV cure-directed research. Our documented experience with implementing the CEG supports greater discussion and independent implementation efforts for this model to engage communities into working teams in a way we find a meaningful, ethical, and sustainable model in support of basic, clinical/biomedical, social sciences and ethics research.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Beth Peterson
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Nora L Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Amy Onorato
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - William B Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Christine Dannaway
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Steven Johnson
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Roy Hayes
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Marcus Hill
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Rease Maddox
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - James L Riley
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jane Shull
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Luis J Montaner
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA.
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Bonney EY, Lamptey H, Kyei GB. HIV cure: an acceptability scientific agenda. Curr Opin HIV AIDS 2023; 18:12-17. [PMID: 36503877 PMCID: PMC9757853 DOI: 10.1097/coh.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Recent years have seen major investments into HIV cure research, seeking a permanent cure or remission. The purpose of this review is to consider how this important research agenda could be broadened to include issues of acceptability and appropriateness for different populations. RECENT FINDINGS We discuss how the definitions of cure such as functional cure (remission) or complete cure (viral elimination) could be interpreted differently by various populations. We also discuss the different methods of cure and the importance of including Africa in cure research to ensure that emerging remedies could be trialled and utilized on the continent that bears the brunt of the AIDS pandemic. SUMMARY We propose that the social science research of HIV cure acceptability should be done concurrently with the basic and clinical sciences, to ensure that cure methods consider stakeholder preferences.
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Affiliation(s)
- Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Helena Lamptey
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
| | - George B. Kyei
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
- Medical and Scientific Research Center, University of Ghana Medical Center, Accra, Ghana
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Dubé K, Campbell CK, Eskaf S, Sauceda JA, Ndukwe S, Henley L, Persaud D, Deeks SG, Auerbach JD, Saberi P. Willingness of Racially Diverse Young Adults Living with HIV to Participate in HIV Cure Research: A Cross-Sectional Survey in the United States. AIDS Res Hum Retroviruses 2022. [PMID: 36226414 PMCID: PMC10387162 DOI: 10.1089/aid.2022.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nearly half of new HIV cases in the United States are among youth. Little is known about the willingness of young adults living with HIV (YLWH) to participate in HIV cure-related research. In 2021, we recruited 271 YLWH aged 18-29 for an online survey. We asked questions about willingness to participate in HIV cure research, perceived risks and benefits, acceptable trade-offs, and perceptions on analytical treatment interruptions. We conducted descriptive analyses to summarize data and bivariate analyses to explore correlations by demographics. Most respondents (mean age = 26) identified as men (86%) and Black Americans (69%). YLWH expressed high willingness to consider participating in cell- and gene-based approaches (75%) and immune-based approaches (71%). Approximately 45% would be willing to let their viral load become detectable for a period of time during an HIV cure study, 27% would not be willing, and 28% did not know. The social risk most likely to deter participation was the possibility of transmitting HIV to sex partners while off HIV medications (65% of respondents would be deterred a great deal or a lot). Compared to the 25-29 age group (n = 192), the 18-24 age group (n = 79) was more likely to indicate that having to disclose HIV status would matter a great deal in considering participation in HIV cure research (38% vs. 21%, p = .003). Inclusion and engagement of YLWH are critical for advancing novel HIV curative agents. Our article concludes with possible considerations for engaging YLWH in HIV cure research. Physical, clinical, and social risks will need to be kept to a minimum, and research teams will need to proactively mitigate the possibility of transmitting HIV to sex partners while off HIV medications.
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Affiliation(s)
- Karine Dubé
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Chadwick K Campbell
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Shadi Eskaf
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - John A Sauceda
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Samuel Ndukwe
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Laney Henley
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Deborah Persaud
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven G Deeks
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco (UCSF). San Francisco, California, USA
| | - Judith D Auerbach
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
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Neergaard R, Jones NL, Roebuck C, Rendle KA, Barbati Z, Peterson B, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dube K, Barg FK. "I know that I was a part of making a difference": Participant motivations for joining a cure-directed HIV trial with an analytical treatment interruption. AIDS Res Hum Retroviruses 2022. [PMID: 35979886 PMCID: PMC10389247 DOI: 10.1089/aid.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Analytical treatment interruption (ATI), defined as a closely monitored clinical pause in antiretroviral therapy, is a core component of many HIV cure-directed clinical studies. ATIs may cause significant physical and psychosocial risks for people living with HIV and, as a result, integrating participant and community perspectives into clinical trial designs that include an ATI is crucial to ensuring a successful and person-centered trial. We conducted semi-structured interviews with participants enrolling in the BEAT-2 cure-directed trial (NCT03588715). Interviews elicited participant motivations and decision-making processes for trial participation as well as participants' perceptions of the ATI. Interviews were recorded, transcribed, and analyzed using a directed content analysis. Fourteen of 15 trial participants completed interviews. The majority were Black (79%) cisgender male (79%). Participants noted several significant motivating factors contributing to their desire to enroll in the HIV cure-directed clinical trial, the most prominent being a desire to find a cure for HIV and help others in the HIV community. HIV care teams were the most commonly identified resource for patients when making the decision to enroll in the trial, and family, friends, and romantic partners also played a significant role. Altruism was a primary motivation for participation, although participants also shared interest in learning about HIV science and research. Participants had a strong understanding of trial procedures and displayed significant trust in the study team to keep them informed and healthy during their participation. The ATI was a significant source of anxiety for participants. Their primary worry was that their prior antiretroviral treatment (ART) regimen would no longer be effective once they resumed ART. Despite these concerns, participants shared considerable excitement for continued participation in the trial and being a part of the search towards an HIV cure.
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Affiliation(s)
- Rebecca Neergaard
- University of Pennsylvania Perelman School of Medicine, Family Medicine and Community Health, Philadelphia, Pennsylvania, United States;
| | - Nora L Jones
- Temple University, Center for Urban Bioethics, Philadelphia, Pennsylvania, United States.,Wistar Institute, BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, Pennsylvania, United States;
| | - Christopher Roebuck
- University of California Berkeley, Anthropology, Berkeley, California, United States.,Wistar Institute, BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, Pennsylvania, United States;
| | - Katharine A Rendle
- University of Pennsylvania Perelman School of Medicine, Family Medicine and Community Health, Philadelphia, Pennsylvania, United States;
| | - Zoe Barbati
- University of Pennsylvania Perelman School of Medicine, Family Medicine and Community Health, Philadelphia, Pennsylvania, United States;
| | - Beth Peterson
- Wistar Institute, Martin Delaney BEAT-HIV Collaboratory, Philadelphia, Pennsylvania, United States;
| | - Pablo Tebas
- University of Pennsylvania, Philadelphia, Pennsylvania, United States;
| | - Karam Mounzer
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States;
| | - David Metzger
- University of Pennsylvania Perelman School of Medicine, Psychiatry, 3535 Market Street, Suite 4000, Philadelphia, Pennsylvania, United States, 19104;
| | - Luis J Montaner
- The Wistar Institute, 3601 Spruce Street, Philadelphia, Pennsylvania, United States, 19104;
| | - Karine Dube
- UNC Gillings School of Global Health Health, Public Health Leadership Program, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, United States, 27516;
| | - Frances K Barg
- University of Pennsylvania Perelman School of Medicine, Family Medicine and Community Health, Philadelphia, Pennsylvania, United States.,University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States;
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11
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Dube K, Agarwal H, Stockman JK, Auerbach JD, Sauceda JA, Conroy A, Johnson M. "I would absolutely need to know that my partner is still going to be protected": Perceptions of HIV Cure-Related Research among Diverse HIV Serodifferent Couples in the United States. AIDS Res Hum Retroviruses 2022. [PMID: 35972752 PMCID: PMC10387158 DOI: 10.1089/aid.2022.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Most HIV cure studies remain in the early stage of investigation and may carry clinical risks to the participants and, in some cases, their partners. Surprisingly little socio-behavioral research has investigated the perceptions of couples - including HIV serodifferent couples - around HIV cure research, including factors that would influence recruitment and retention in trials. We conducted a qualitative study to explore perceptions of diverse HIV serodifferent partners in the U.S. We recruited 10 diverse HIV serodifferent couples (20 participants). We found participants had learned to cope with the reality of HIV, including protections during sex, and ascribed both positive and negative meanings to an HIV cure. Partners expressed concern about other's health and potentially caring for a sick partner and emphasized the importance of safety when participating in an HIV cure trial. They identified the need for partner protection measures during analytical treatment interruptions (ATIs) as an ethical imperative. Participants recounted experiences of HIV stigma due to being in HIV serodifferent relationships and viewed ATIs as leading to a detectable viral load, which could limit sexual expression, complicate disclosure decision making, and worsen HIV-related stigma. Our study's main contribution is to inform efforts to meaningfully engage diverse HIV serodifferent partners in HIV cure research in the U.S. Our data suggest PWH make decisions to participate in research based on close ones in their life and underscore the critical importance of acknowledging relationship dynamics in decisions to participate in research.
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Affiliation(s)
- Karine Dube
- UNC Gillings School of Global Health Health, Public Health Leadership Program, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, United States, 27516;
| | - Harsh Agarwal
- UNC-Chapel Hill, Chapel Hill, North Carolina, United States;
| | - Jamila K Stockman
- University of California, San Diego, San Diego, California, United States;
| | - Judith D Auerbach
- University of California, San Francisco, School of Medicine, San Francisco, United States;
| | - John A Sauceda
- University of California San Francisco, Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, San Francisco, United States;
| | - Amy Conroy
- University of California San Francisco, San Francisco, California, United States;
| | - Mallory Johnson
- University of California, San Francisco, Medicine, San Francisco, California, United States;
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12
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Participant experiences using novel home-based blood collection device for viral load testing in the HIV cure trials with analytical treatment interruptions. HIV Res Clin Pract 2022; 23:76-90. [PMID: 35968737 PMCID: PMC9403870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: HIV cure-directed clinical trials using analytical treatment interruptions (ATIs) require participants to adhere to frequent monitoring visits for viral load tests. Novel viral load monitoring strategies are needed to decrease participant burden during ATIs.Objective: To examine acceptability of a novel home-based blood collection device for viral load testing in the context of two ongoing ATI trials in Philadelphia, PA, United States.Methods: From January 2021 to February 2022, participants completed three in-depth interviews via teleconference during their participation in an ATI: (1) within two weeks of enrollment in the device study, (2) approximately four weeks after beginning to use the device, and (3) within two weeks of the end of the ATI when ART was re-initiated. We used conventional content analysis to analyze the data.Results: We recruited 17 participants: 15 were cisgender males, 1 cisgender female, and 1 transgender woman. We observed an overall 87% success rate in drawing blood with the device from home collection and found overall high acceptance of the device. A mean of 91.5 devices per participant were used for home-based blood collection. Most PWH viewed the device as relatively convenient, painless, easy to use, and a simple solution to frequent blood draws. The main challenge encountered was the inability to completely fill up devices with blood in some cases. Most participants reported positive experiences with mailing blood samples and could see themselves using the device on a regular basis outside of ATIs.Conclusions: Our study showed participant valued the novel home-based peripheral blood collection for viral load testing in the context of ATI trials. More research will be necessary to optimize implementation of the device and to assess whether blood collected can reliably measure viral loads in the context of ATI trials.
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13
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Saberi P, Campbell CK, Sauceda JA, Ndukwe S, Dubé K. Perceptions of Risks and Benefits of Participating in HIV Cure-Related Research Among Diverse Young Adults Living with HIV in the United States: Qualitative Research Findings. AIDS Res Hum Retroviruses 2022; 38:649-659. [PMID: 35579937 PMCID: PMC9464049 DOI: 10.1089/aid.2021.0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the United States, young adults have the highest rates of new HIV infections, and are less likely to be aware of their infection, be engaged in care, or achieve HIV viral suppression. As biomedical HIV research increasingly focuses on achieving long-term suppression without antiretroviral therapy (ART) and finding an HIV cure, little is known about perceptions of young adults living with HIV (YLWH) regarding HIV cure research. We recruited a diverse sample of 20 YLWH (18-29 years old) to participate in individual semistructured qualitative interviews to explore knowledge and perceptions of HIV cure research, and motivations and barriers to participation. Most participants had little knowledge of HIV cure research. Motivators of HIV cure research participation included altruism, stigma reduction, and the elimination of the clinical burdens of HIV. Barriers included potential physical side effects, psychological distress, the possibility of disclosure as a result of participating, and the amount of time required to participate. Most participants had concerns about analytic treatment interruptions (i.e., ART interruption to assess HIV remission), and indicated that they would want more frequent laboratory testing and protection for their sex partners during this time. Finally, participants suggested that, if other YLWH are considering participation in cure research, they should first learn as much as possible about the research, and then consider the potential personal benefits and the contribution that they could make to science and their communities. As HIV cure research advances, the participation of YLWH will be critical. Our study provides knowledge about how YLWH view HIV cure research. More sociobehavioral research is needed to ensure that those who are most likely to be the decision-makers and beneficiaries of an HIV cure are included at all levels of research.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Parya Saberi, Department of Medicine, University of California, San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143, USA
| | - Chadwick K. Campbell
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, California, USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, California, USA
| | - Samuel Ndukwe
- School of Global Public Health, University of North Carolina Gillings, Chapel Hill, North Carolina, USA
| | - Karine Dubé
- School of Global Public Health, University of North Carolina Gillings, Chapel Hill, North Carolina, USA
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14
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Sylla L, Patel H, Louella M, Simoni J, Dubé K. Community HIV clinicians' perceptions about HIV cure-related research in the Northwestern United States. HIV Res Clin Pract 2022; 23:61-75. [PMID: 35904107 PMCID: PMC9836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Research on stakeholder perspectives of HIV cure research has involved people with HIV (PWH), who generally cite the importance of HIV clinician advice in making decisions about trial participation. However, there has been little exploration of non-researcher community HIV clinician perspectives, which are clearly critical to the success of HIV cure-related research.Objective: We aimed to learn how community HIV clinicians perceive HIV cure research and identify factors that would lead them to support or discourage HIV cure trial participation by their patients.Methods: We recruited a purposive sample of 12 community HIV clinicians in metro-Seattle, WA to participate in structured interviews. We completed 11 interviews via teleconference and received one written response. We used conventional content analysis to analyze the data.Results: Overall, community HIV clinicians were supportive of patient participation in HIV cure trials. Factors affecting support included knowledge of local trials, ease of referral, patient immune function and health stability, study risks and benefits, burden of study requirements, patient characteristics, patient life stability, potential impact on engagement in care, study communication plans, and beliefs that patients should have the autonomy to decide to participate. Participants had concerns about trials requiring treatment delays or interruptions and HIV transmission risk. While their knowledge of the field was limited, they were interested in learning more about open HIV cure trials.Conclusions: It would benefit the HIV cure research community if those leading HIV cure trials make stronger efforts to engage community clinicians who care for PWH, but are not active researchers, early in the trial design process. Such engagement prior to launching HIV cure trials will improve trial designs, leading to better enrollment and retention within these important studies.
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Affiliation(s)
- Laurie Sylla
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA,University of Washington, School of Medicine, Division of Allergy and Infectious Diseases, Mountain West AIDS Education & Training Center, Mailstop 359932, Seattle, WA 98104
| | - Hursch Patel
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Michael Louella
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA
| | - Jane Simoni
- University of Washington, Departments of Psychology and Global Health, 3909 Stevens Way CE, Box 351525, Seattle, WA, USA
| | - Karine Dubé
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
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15
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Dubé K, Eskaf S, Barr L, Palm D, Hogg E, Simoni JM, Sugarman J, Brown B, Sauceda JA, Henley L, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ. Participant Perspectives and Experiences Following an Intensively Monitored Antiretroviral Pause in the United States: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2022; 38:510-517. [PMID: 35323030 PMCID: PMC9225827 DOI: 10.1089/aid.2021.0170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The AIDS Clinical Trials Group A5345 study (NCT03001128) included an intensively monitored antiretroviral pause (IMAP), during which participants living with HIV temporarily stopped antiretroviral treatment (ART) in an effort to identify biomarkers that could predict HIV rebound. We evaluated the potential impact of the IMAP on A5345 study participants in the United States by questioning them immediately after the IMAP and at the end of the study. We administered longitudinal sociobehavioral questionnaires to participants following the IMAP when they resumed ART and at the end of the study. We summarized descriptive data from the post-IMAP and end-of-study questionnaires. Open-ended responses were analyzed using conventional content analysis. Reactions to pausing ART involved a mixture of curiosity and satisfaction from contributing to science. All participants indicated adherence with the ART interruption. About half (9/17) of post-IMAP questionnaire respondents reported having sexual partner(s) during the IMAP, and of those, nearly all (8/9) did not find it difficult to use measures to prevent HIV transmission to partners. The majority believed that they benefited from the study, yet some had elevated anxiety following the IMAP and at the end of the study. Most (24/29) respondents who completed the end-of-study questionnaire would recommend the study to other people living with HIV. Our findings underscore the relevance of the psychosocial aspects of participating in studies that involve interruptions of ART. Understanding how participants experience this research is invaluable for informing the design of future research aimed at sustained ART-free virologic suppression.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Address correspondence to: Karine Dubé, Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, 4108 McGavran Greenberg Hall, Campus Box 7469, Chapel Hill, NC 27599-7469, USA
| | - Shadi Eskaf
- UNC School of Government, Chapel Hill, North Carolina, USA
| | - Liz Barr
- Community Scientific Sub-Committee, AIDS Clinical Trials Group (ACTG), Baltimore, Maryland, USA
| | - David Palm
- Community Scientific Sub-Committee, AIDS Clinical Trials Group (ACTG), Baltimore, Maryland, USA.,Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social and Scientific Systems, Inc., a DLH Holdings Company, Silver Spring, Maryland, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA.,Department of Global Health, and Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA.,Department of Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Center for Healthy Communities, Department of Social Medicine, Population and Public Health, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Laney Henley
- Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA
| | - Lawrence Fox
- Division of AIDS (DAIDS), National Institute of Health (NIH), Bethesda, Maryland, USA
| | - Rajesh T. Gandhi
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Peay HL, Rennie S, Cadigan RJ, Gwaltney A, Jupimai T, Phanuphak N, Kroon E, Colby DJ, Ormsby N, Isaacson SC, Vasan S, Sacdalan C, Prueksakaew P, Benjapornpong K, Ananworanich J, Henderson GE. Attitudes About Analytic Treatment Interruption (ATI) in HIV Remission Trials with Different Antiretroviral Therapy (ART) Resumption Criteria. AIDS Behav 2022; 26:1504-1516. [PMID: 34997386 PMCID: PMC9007833 DOI: 10.1007/s10461-021-03504-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
HIV remission trials often require temporary stopping of antiretroviral therapy (ART)-an approach called analytic treatment interruption (ATI). Trial designs resulting in viremia raise risks for participants and sexual partners. We conducted a survey on attitudes about remission trials, comparing ART resumption criteria (lower-risk "time to rebound" and higher-risk "sustained viremia") among participants from an acute HIV cohort in Thailand. Analyses included Wilcoxon-Ranks and multivariate logistic analysis. Most of 408 respondents supported ATI trials, with slightly higher approval of, and willingness to participate in, trials using time to rebound versus sustained viremia criteria. Less than half of respondents anticipated disclosing trial participation to partners and over half indicated uncertainty or unwillingness about whether partners would be willing to use PrEP. Willingness to participate was higher among those who rated higher trial approval, lower anticipated burden, and those expecting to make the decision independently. Our findings support acceptability of ATI trials among most respondents. Participant attitudes and anticipated behaviors, especially related to transmission risk, have implications for future trial design and informed consent.
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17
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Dubé K, Eskaf S, Hastie E, Agarwal H, Henley L, Roebuck C, Carter WB, Dee L, Taylor J, Mapp D, Campbell DM, Villa TJ, Peterson B, Lynn KM, Lalley-Chareczko L, Hiserodt E, Kim S, Rosenbloom D, Evans BR, Anderson M, Hazuda DJ, Shipley L, Bateman K, Howell BJ, Mounzer K, Tebas P, Montaner LJ. Preliminary Acceptability of a Home-Based Peripheral Blood Collection Device for Viral Load Testing in the Context of Analytical Treatment Interruptions in HIV Cure Trials: Results from a Nationwide Survey in the United States. J Pers Med 2022; 12:231. [PMID: 35207719 PMCID: PMC8879991 DOI: 10.3390/jpm12020231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Frequent viral load testing is necessary during analytical treatment interruptions (ATIs) in HIV cure-directed clinical trials, though such may be burdensome and inconvenient to trial participants. We implemented a national, cross-sectional survey in the United States to examine the acceptability of a novel home-based peripheral blood collection device for HIV viral load testing. Between June and August 2021, we distributed an online survey to people with HIV (PWH) and community members, biomedical HIV cure researchers and HIV care providers. We performed descriptive analyses to summarize the results. We received 73 survey responses, with 51 from community members, 12 from biomedical HIV cure researchers and 10 from HIV care providers. Of those, 51 (70%) were cisgender men and 50 (68%) reported living with HIV. Most (>80% overall) indicated that the device would be helpful during ATI trials and they would feel comfortable using it themselves or recommending it to their patients/participants. Of the 50 PWH, 42 (84%) indicated they would use the device if they were participating in an ATI trial and 27 (54%) also expressed a willingness to use the device outside of HIV cure studies. Increasing sensitivity of viral load tests and pluri-potency of the device (CD4 count, chemistries) would augment acceptability. Survey findings provide evidence that viral load home testing would be an important adjunct to ongoing HIV cure-directed trials involving ATIs. Survey findings may help inform successful implementation and uptake of the device in the context of personalized HIV care.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Shadi Eskaf
- Independent Public Health Researcher and Consultant, Chapel Hill, NC 27516, USA;
| | - Elizabeth Hastie
- School of Medicine, University of California San Diego, La Jolla, CA 92093, USA;
| | - Harsh Agarwal
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Laney Henley
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (H.A.); (L.H.)
| | - Christopher Roebuck
- Department of Science and Technology Studies, Cornell University, Ithaca, NY 14850, USA;
- Martin Delaney BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, PA 19104, USA;
| | - William B. Carter
- Martin Delaney BEAT-HIV Collaboratory Community Advisory Board (CAB), Philadelphia, PA 19104, USA;
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD 21202, USA;
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
| | - Jeff Taylor
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
- HIV + Aging Research Project-Palm Springs (HARP-PS), Palm Springs, CA 92264, USA
| | - Derrick Mapp
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
- Shanti Project, San Francisco, CA 94109, USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA 94110, USA; (J.T.); (D.M.C.)
- AIDS Treatment Activists Coalition (ATAC), Denver, CO 80209, USA;
| | - Thomas J. Villa
- HOPE Martin Delaney Collaboratory, San Francisco, CA 94612, USA;
- BELIEVE Martin Delaney Collaboratory, Washington, DC 10021, USA
- National HIV & Aging Advocacy Network, Washington, DC 20005, USA
| | - Beth Peterson
- Wistar Institute, Martin Delaney BEAT-HIV Collaboratory, Philadelphia, PA 19104, USA; (B.P.); (L.J.M.)
| | - Kenneth M. Lynn
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | | | - Emily Hiserodt
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA 19107, USA; (L.L.-C.); (E.H.)
| | - Sukyung Kim
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | - Daniel Rosenbloom
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Brad R. Evans
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Melanie Anderson
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Daria J. Hazuda
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Lisa Shipley
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Kevin Bateman
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Bonnie J. Howell
- Merck & Co, Inc., Kenilworth, NJ 07033, USA; (D.R.); (B.R.E.); (M.A.); (D.J.H.); (L.S.); (K.B.); (B.J.H.)
| | - Karam Mounzer
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA 19107, USA; (L.L.-C.); (E.H.)
| | - Pablo Tebas
- Hospital of the University of Pennsylvania, Philadelphia, PA 19107, USA; (K.M.L.); (S.K.); (K.M.); (P.T.)
| | - Luis J. Montaner
- Wistar Institute, Martin Delaney BEAT-HIV Collaboratory, Philadelphia, PA 19104, USA; (B.P.); (L.J.M.)
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18
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The perceived impact of an HIV cure by people living with HIV and key populations vulnerable to HIV in the Netherlands: A qualitative study. J Virus Erad 2022; 8:100066. [PMID: 35280938 PMCID: PMC8907669 DOI: 10.1016/j.jve.2022.100066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction When an HIV cure becomes available, it will have consequences for people living with HIV (PLHIV) and key populations who are vulnerable to HIV. This qualitative study aimed to explore the perceived impact of two HIV cure scenarios (post-treatment control when HIV is suppressed without the need for ongoing antiretroviral treatment (ART) and complete HIV elimination) on the quality of life of PLHIV and key populations living without HIV in the Netherlands. Methods Participants were purposefully sampled from the Amsterdam Cohort Studies, the AGEhIV Cohort Study, the outpatient clinic of the University Medical Centre Utrecht and the Dutch HIV Association to increase variability. Semi-structured in-depth interviews were conducted between October 2020 and March 2021 and thematically analysed. Results Of the 42 interviewed participants, 29 were PLHIV and 13 represented key populations (i.e., men who have sex with men and people injecting drugs). Both PLHIV and participants from vulnerable key populations hoped that a cure would result in normalization of their lives by removing the need to disclose HIV, reducing stigma and guilt, increasing independence of ART, and liberating sexual behaviour. Both groups believed only HIV elimination could accomplish this desired impact. Conclusions While the post-treatment control scenario seems a more plausible outcome of current HIV cure research, our findings highlight that participants may not perceive it as a true cure. Involvement of PLHIV and vulnerable key populations in devising acceptable and feasible experimental approaches to HIV cure is essential to ensure their future successful implementation.
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Makhakhe NF, MeyerWeitz A, Sliep Y. Motivating factors associated with oral pre-exposure prophylaxis use among female sex workers in South Africa. J Health Psychol 2022; 27:2820-2833. [PMID: 34991407 DOI: 10.1177/13591053211072674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To explore the motivating factors that encourage female sex workers to take oral PrEP, despite the challenges that come with adherence. The 39 participants in this study consisted of female sex workers, peer educators, a counselor, and a researcher. Participants took PrEP as an expression of self-love. Some participants described PrEP as empowering because they could independently prevent HIV. They were also motivated by parenting, hope and future aspirations. It is important for future PrEP interventions to incorporate behavioral strategies that appeal to the user's personal and deeper motivations for living.
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Saberi P, Campbell CK, Venegas M, Dubé K. Time to Engage Young People in HIV Cure Research. AIDS Res Hum Retroviruses 2022; 38:2-4. [PMID: 33677996 PMCID: PMC8785756 DOI: 10.1089/aid.2020.0268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Antiretroviral treatments successfully suppress and control HIV but cannot eliminate the virus. In recent years, much research has gone into developing a cure for HIV. This research comes with significant risks and limited clinical benefits to study participants. Little is known about the knowledge, willingness, motivations, and barriers of participating in HIV cure-related research. This is particularly true among young people living with HIV (YLWH), despite those <30 years having the highest HIV infection rates in the United States. YLWH have experienced a different phase of the HIV epidemic from their older counterparts. To guide HIV cure research development, more resources need to be directed toward understanding the perspectives of YLWH and meaningfully involving them in research. As the field of HIV cure research continues to grow and innovate, it is critical that we proactively engage YLWH as they will soon be at the forefront of decision making toward ending the HIV epidemic.
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Affiliation(s)
- Parya Saberi
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Chadwick K. Campbell
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Manuel Venegas
- Fred Hutchinson Cancer Research Center, defeatHIV Community Advisory Board, Seattle, Washington, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Public Health Leadership Program, Chapel Hill, North Carolina, USA
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21
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Gilbertson A, Tucker JD, Dubé K, Dijkstra M, Rennie S. Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection. BMC Med Ethics 2021; 22:169. [PMID: 34961509 PMCID: PMC8714439 DOI: 10.1186/s12910-021-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retention. The purpose of this paper is to identify potential ethical challenges associated with involving acutely diagnosed people living with HIV in remission research and considerations for how to mitigate them. We identify three domains of potential ethical concern for clinicians, researchers, and ethics committee members to consider: 1) Recruitment and informed consent; (2) Transmission risks and partner protection; and (3) Ancillary and continuing care. We discuss each of these domains with the aim of inspiring further work to advance the ethical conduct of HIV remission research. For example, experiences of confusion and uncertainty regarding illness and diagnosis during acute HIV infection may complicate informed consent procedures in studies that seek to recruit directly after diagnosis. To address this, it may be appropriate to use staged re-consent procedures or comprehension assessment. Responsible conduct of research requires a broad understanding of acute HIV infection that encompasses its biomedical, psychological, social, and behavioral dimensions. We argue that the lived experience of acute HIV infection may introduce ethical concerns that researchers and reviewers should address during study design and ethical approval.
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Affiliation(s)
- Adam Gilbertson
- Pacific Institute for Research and Evaluation, Chapel Hill Center, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514-7038, USA. .,UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WCE1, UK.,UNC Project-China, 2 Lujing Road, Guangzhou, China
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maartje Dijkstra
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Stuart Rennie
- UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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22
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Dubé K, Kanazawa J, Dee L, Taylor J, Sauceda JA, Gianella S, Smith D, Deeks SG, Peluso MJ. Considerations for designing and implementing combination HIV cure trials: findings from a qualitative in-depth interview study in the United States. AIDS Res Ther 2021; 18:75. [PMID: 34663375 PMCID: PMC8522863 DOI: 10.1186/s12981-021-00401-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasing number of HIV cure trials involve combining multiple potentially curative interventions. Until now, considerations for designing and implementing complex combination HIV cure trials have not been thoroughly considered. METHODS We used a purposive method to select key informants for our study. Informants included biomedical HIV cure researchers, regulators, policy makers, bioethicists, and community members. We used in-depth interviews to generate ethical and practical considerations to guide the design and implementation of combination HIV cure research. We analyzed the qualitative data using conventional content analysis focused on inductive reasoning. RESULTS We interviewed 11 biomedical researchers, 4 community members, 2 regulators, 1 policy researcher, and 1 bioethicist. Informants generated considerations for designing and implementing combination interventions towards an HIV cure, focused on ethical aspects, as well as considerations to guide trial design, benefit/risk determinations, regulatory requirements, prioritization and sequencing and timing of interventions, among others. Informants also provided considerations related to combining specific HIV cure research modalities, such as broadly neutralizing antibodies (bNAbs), cell and gene modification products, latency-reversing agents and immune-based interventions. Finally, informants provided suggestions to ensure meaningful therapeutic improvements over standard antiretroviral therapy, overcome challenges of designing combination approaches, and engage communities around combination HIV cure research. CONCLUSION The increasing number of combination HIV cure trials brings with them a host of ethical and practical challenges. We hope our paper will inform meaningful stakeholder dialogue around the use of combinatorial HIV cure research approaches. To protect the public trust in HIV cure research, considerations should be periodically revisited and updated with key stakeholder input as the science continues to advance.
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Affiliation(s)
- Karine Dubé
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599 USA
- UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27516 USA
| | - John Kanazawa
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599 USA
| | - Lynda Dee
- AIDS Action Baltimore, 14 East Eager Street, Baltimore, MD 21202 USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), 995 Potrero Avenue, San Francisco, CA 94110 USA
| | - Jeff Taylor
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), 995 Potrero Avenue, San Francisco, CA 94110 USA
- HIV+Aging Research Project-Palm Springs (H+ARP-PS), 1775 East Palm Canyon Drive, Suite 110-349, Palm Springs, CA 92264 USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), 550 16th Street, 3rd Floor, San Francisco, CA 94158 USA
| | - Sara Gianella
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
| | - Davey Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093 USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA 92103 USA
| | - Steven G. Deeks
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), Ward 84, Building 80, San Francisco, CA 94110 USA
| | - Michael J. Peluso
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), Ward 84, Building 80, San Francisco, CA 94110 USA
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23
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Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. Methods We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. Discussion Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). Conclusion HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA.
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Jeff Taylor
- HIV + Aging Research Project - Palm Springs (HARP-PS), Palm Springs, CA, USA.,AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA, USA.,Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA.,Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA, USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C., USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA.,Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle M Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA.,Charles R. Drew College of Medicine and Science, Los Angeles, CA, USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA.,Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA
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24
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Diepstra KL, Barr L, Palm D, Hogg E, Mollan KR, Henley L, Stover AM, Simoni JM, Sugarman J, Brown B, Sauceda JA, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ, Dubé K. Participant Perspectives and Experiences Entering an Intensively Monitored Antiretroviral Pause: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2021; 37:489-501. [PMID: 33472545 DOI: 10.1089/aid.2020.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The AIDS Clinical Trials Group (ACTG) A5345 study included an intensively monitored antiretroviral pause (IMAP), during which a cohort of participants temporarily stopped antiretroviral treatment during chronic HIV infection. We surveyed participant perceptions and understanding of A5345 using a cross-sectional sociobehavioral questionnaire. Participants completed the baseline questionnaire either before or after initiating the study's IMAP. Questionnaire responses were linked to existing demographic data. Quantitative responses were analyzed overall and stratified by IMAP status. Open-ended responses were analyzed using conventional content analysis. Thirty-two participants completed the baseline sociobehavioral questionnaire. Half (n = 16) completed it before (i.e., pre-IMAP initiation group) and half (n = 16) after IMAP initiation (i.e., post-IMAP initiation group). Eight pre-IMAP initiation respondents (50%) and 11 post-IMAP respondents (69%) responded "yes" when asked if they perceived any direct benefits from participating in A5345. Perceived societal-level benefits included furthering HIV cure-related research and helping the HIV community. Perceived personal-level benefits included the opportunity to learn about the body's response to IMAP and financial compensation. The majority of respondents-13 from each group (81% of each)-reported risks from participation, for example, viral load becoming detectable. A5345 participants perceived both societal- and personal-level benefits of study participation. While the majority of survey respondents perceived participatory risks, nearly one in five did not. Key messages pertaining to study-related risks and benefits may need to be clarified or reiterated periodically throughout follow-up in HIV cure-related studies with IMAPs. Clinical Trail Registration Number: NCT03001128.
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Affiliation(s)
- Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Sub-Committee, Baltimore, Maryland, USA
| | - David Palm
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Katie R. Mollan
- Center for AIDS Research (CFAR), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laney Henley
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M. Stover
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health and Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lawrence Fox
- National Institute of Health (NIH) Division of AIDS (DAIDS), Bethesda, Maryland, USA
| | | | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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25
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Kanazawa JT, Saberi P, Sauceda JA, Dubé K. The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review. AIDS Res Hum Retroviruses 2021; 37:75-88. [PMID: 33176429 PMCID: PMC8020525 DOI: 10.1089/aid.2020.0126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) is one of the latest advancements in HIV control with the potential to overcome oral ART barriers to adherence. The objective of this article is to anticipate and examine implementation considerations for LAI-ART using components of the PRISM model, a Practical, Robust Implementation and Sustainability Model for integrating research findings into practice. We conducted a scoping review from January to August 2020 of the growing literature on LAI-ART implementation and other fields using LAI therapies. Key considerations regarding LAI-ART were parsed from the searches and entered into the PRISM implementation science framework. The PRISM framework posed multiple questions for consideration in the development of an optimal implementation strategy for LAI-ART in the United States. These questions revealed the necessity for more data, including acceptability of LAI-ART among many different subgroups of people living with HIV (PLWH), cost effectiveness, patient satisfaction, and patient-reported outcomes, as well as more detailed information related to the external environment for optimal LAI-ART implementation. Ethical considerations of LAI-ART will also need to be considered. The anticipation of, and excitement for, LAI-ART represent the hope for a new direction for HIV treatment that reduces adherence barriers and improves prognoses for PLWH. We have a unique window of opportunity to anticipate implementation considerations for LAI-ART, so this new therapy can be used to its fullest potential. Outstanding questions remain, however, that need to be addressed to help achieve HIV suppression goals in diverse populations.
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Affiliation(s)
- John T. Kanazawa
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
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26
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De Scheerder MA, van Bilsen WPH, Dullaers M, Martinez-Picado J, Davidovich U, Vandekerckhove L. Motivations, barriers and experiences of participants in an HIV reservoir trial. J Virus Erad 2021; 7:100029. [PMID: 33598311 PMCID: PMC7868726 DOI: 10.1016/j.jve.2021.100029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives We aimed to investigate the motives, barriers and experiences of HIV-STAR study participants. The HIV-STAR study was an analytical HIV treatment interruption trial (ATI) aiming to evaluate the origin of viral rebound, conducted in Ghent, Belgium. Methods A mixed-method study was performed among 11 participants of the HIV-STAR study. Two self-administered questionnaires with 32 and 23 items, respectively, assessed motives, barriers and experiences of the research participants. In-depth interviews were conducted to further explore and understand topics that had emerged from these surveys. Results Motives of ATI study participants were primarily related to the improvement of their own health perspectives and to their contribution to find an HIV cure. Barriers for ATI participation mostly related to practical issues, such as difficulty in planning study visits. Ten out of 11 participants reported a very high overall satisfaction and were willing to participate in another ATI. This satisfaction was predominantly linked to clear communication and guidance. Invasive sampling during the ATI was less of a burden than anticipated by participants. However, most participants underestimated the emotional impact of HIV treatment interruption, which was associated with feelings of uncertainty and loss of control. Risk of HIV transmission because of viral rebound was also mentioned as burdensome during this phase. Conclusions Involvement in an ATI was positively evaluated by HIV-STAR participants. Contributing to HIV cure research outweighed the burden of study participation for most participants. The latter aspects were attenuated by mutual decision making and the experience of empathy from the research team. Still, issues regarding privacy and the psychosocial impact of treatment interruption, including sexuality and HIV transmissibility, should be addressed in a better way.
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Affiliation(s)
| | - Ward P H van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | | | - Javier Martinez-Picado
- IRSICaixa AIDS Research Institute, Badalona, Spain.,University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Linos Vandekerckhove
- Department of General Internal Medicine, University Hospital Ghent, Ghent, Belgium
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27
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Poteat T, Aqil A, Corbett D, Evans D, Dubé K. "I would really want to know that they had my back": Transgender women's perceptions of HIV cure-related research in the United States. PLoS One 2020; 15:e0244490. [PMID: 33382760 PMCID: PMC7774946 DOI: 10.1371/journal.pone.0244490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Forty-four percent of Black transgender women are living with HIV, and many face challenges with HIV care engagement. An HIV cure has much to offer this population, however little HIV cure-related research has included them. We conducted 19 face-to-face in-depth interviews with 10 Black transgender women living with HIV. Interviews were audio recorded, transcribed verbatim, coded, and analyzed using content analysis. Our interview guide contained three categories: 1) perceptions of HIV cure-related research and participation, 2) perceptions of HIV treatment and treatment interruptions, and 3) considerations for transgender women and HIV cure-related research. Salient themes included skepticism about HIV cure strategies and limited benefits compared with an undetectable viral load. Willingness to interrupt HIV treatment for research was low and linked to being able to go back on the same HIV treatment without consequence when the study ended. Concerns about being a test subject and perceptions of risks versus benefits of various strategies also affected willingness to take part in HIV cure-related research. Centering the dignity and autonomy of research participants as well as building upon and supporting existing social networks were identified as important facilitators for engaging Black transgender women in HIV cure-related research. Specific to Black transgender women, other concerns included the desire for gender-affirming research staff, community-building among transgender women, and safety issues associated with risk of transphobic violence when traveling to study visits. Participants stressed the importance of HIV cure-related researchers providing accessible and complete information and expressing genuine care and concern for transgender communities.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Anushka Aqil
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dana Corbett
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, New York City, New York, United States of America
| | - Karine Dubé
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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28
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Hardy WD. Analytical Treatment Interruptions and Human Immunodeficiency Virus Cure Research: Seizing the Opportunity While Maintaining Safety and Respect. Clin Infect Dis 2020; 70:1418-1420. [PMID: 31102443 DOI: 10.1093/cid/ciz421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 01/11/2023] Open
Affiliation(s)
- W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Washington, DC
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29
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Sauceda JA, Dubé K, Brown B, Pérez AE, Rivas CE, Evans D, Fisher CB. Framing a Consent Form to Improve Consent Understanding and Determine How This Affects Willingness to Participate in HIV Cure Research: An Experimental Survey Study. J Empir Res Hum Res Ethics 2020; 16:78-87. [PMID: 33307932 DOI: 10.1177/1556264620981205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV cure research carries serious risks and negligible benefits. We investigated how participants understand these risks and what influences their willingness to participate. Through internet-based and in-person convenience sampling, 86 HIV+ participants completed an experimental survey. Participants were randomized to read a standard consent form describing a hypothetical HIV cure study or one adapted using Fuzzy Trace Theory-a decision-making model to facilitate complex information processing. We measured consent understanding and cognitive (e.g., safe/harmful) and affective (e.g., concerning, satisfying) evaluations of HIV cure research. Participants who read the adapted consent form had improved consent understanding, but only positive affective evaluations were associated with a willingness to participate. Consent processes can use decision-making theories to facilitate comprehension of study information.
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Affiliation(s)
| | - Karine Dubé
- 2331University of North Carolina Chapel Hill, USA
| | | | | | | | - David Evans
- 455669Delaney AIDS Research Enterprise Martin Delaney Collaboratory Community Advisory Board, San Francisco, CA, USA
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Dubé K, Campbell DM, Perry KE, Kanazawa JT, Saberi P, Sauceda JA, Poteat T, Evans D. Reasons People Living with HIV Might Prefer Oral Daily Antiretroviral Therapy, Long-Acting Formulations, or Future HIV Remission Options. AIDS Res Hum Retroviruses 2020; 36:1054-1058. [PMID: 32829645 DOI: 10.1089/aid.2020.0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A growing body of research is beginning to elucidate reasons people living with HIV (PLWHIV) might prefer oral daily antiretroviral treatment (ART) compared with emerging long-acting ART (LA-ART) or HIV remission strategies under investigation. Our objective is to provide qualitative insights into the reasons why PLWHIV might prefer one of these HIV control therapies over others. From May to August 2018, we implemented a semistructured cross-sectional survey of PLWHIV in the United States to better understand patient preferences around various HIV treatment and remission options. Using free text, respondents were asked to explain why they preferred one HIV control option over the other two. We analyzed responses to the open-ended survey questions on reasons for preferring oral daily ART versus LA-ART versus HIV remission strategies using conventional content analysis. The results showed that PLWHIV preferred oral daily ART because of its familiarity and known safety and efficacy profile, whereas those who preferred LA-ART would value the convenience it offers. Finally, HIV remission strategies would be preferred to avoid taking ART altogether. The qualitative results provide insights into reasons why PLWHIV in the United States might prefer oral daily ART versus novel therapies. More importantly, they provide information to better align HIV virological control strategies with end-user perspectives. To make informed choices around evolving HIV therapeutics, PLWHIV and HIV care providers would benefit from decision tools to better assess options and trade-offs. More research is needed on how best to effectively support PLWHIV and HIV care providers in shared decision-making.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danielle M. Campbell
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California, USA
| | - Kelly E. Perry
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John T. Kanazawa
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Tonia Poteat
- Department of Social Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California, USA
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Lau JSY, Smith MZ, Allan B, Martinez C, Power J, Lewin SR, McMahon JH. Acceptability, motivation and the prospect of cure for people living with HIV and their healthcare providers in HIV cure-focused treatment interruption studies. AIDS Res Ther 2020; 17:65. [PMID: 33168019 PMCID: PMC7653743 DOI: 10.1186/s12981-020-00321-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background Analytical treatment interruptions (ATI) are commonly used clinical endpoints to assess interventions aimed at curing HIV or achieving antiretroviral therapy (ART)-free HIV remission. Understanding the acceptability of ATI amongst people living with HIV (PLHIV) and their HIV healthcare providers (HHP) is limited. Methods Two online surveys for PLHIV and HHP assessed awareness and acceptability of ATI, and understanding of the prospect for HIV cure in the future. Responses were collected from July 2017–January 2018. A descriptive analysis was performed and similar questions across the two surveys were compared using χ squared test. Results 442 PLHIV and 144 HHP completed the survey. 105/400 (26%) PLHIV had ever interrupted ART, 8% of which were in a clinical trial. Altruistic motivations were drivers of participation of PLHIV in cure related research. 81/135 (60%) HHP would support their patients wishing to enrol in an HIV cure-focused trial, but fewer would promote and allow such participation (25% and 31% respectively). Compared to HHP, PLHIV were more likely to believe that an HIV cure would be achievable within 10 years (55% vs. 19%, p < 0.001), had less awareness of ATI (46% vs. 62%, p < 0.001) and were less likely to have had experience of either participation or enrolment in an ATI study (5% vs. 18%, p < 0.001) Conclusion PLHIV were more optimistic about the potential for HIV cure. HHP had more direct experience with HIV cure-focused studies. Educational strategies are required for both groups to increase understanding around ATIs in HIV cure research but should be tailored specifically to each group.
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Dubé K, Perry KE, Mathur K, Lo M, Javadi SS, Patel H, Concha-Garcia S, Taylor J, Kaytes A, Dee L, Campbell D, Kanazawa J, Smith D, Gianella S, Auerbach JD, Saberi P, Sauceda JA. Altruism: Scoping review of the literature and future directions for HIV cure-related research. J Virus Erad 2020; 6:100008. [PMID: 33294210 PMCID: PMC7695811 DOI: 10.1016/j.jve.2020.100008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The question of what motivates people to participate in research is particularly salient in the HIV field. While participation in HIV research was driven by survival in the 1980's and early 1990's, access to novel therapies became the primary motivator with the advent of combination antiretroviral therapy (cART) in the late 1990s. In the HIV cure-related research context, the concept of altruism has remained insufficiently studied. METHODS We conducted a scoping review to better contextualize and understand how altruism is or could be operationalized in HIV cure-related research. We drew from the fields of altruism in general, clinical research, cancer, and HIV clinical research-including the HIV prevention, treatment, and cure-related research fields. DISCUSSION Altruism as a key motivating factor for participation in clinical research has often been intertwined with the desire for personal benefit. The cancer field informs us that reasons for participation usually are multi-faceted and complex. The HIV prevention field offers ways to organize altruism-either by the types of benefits achieved (e.g., societal versus personal), or the origin of the values that motivate research participation. The HIV treatment literature reveals the critical role of clinical interactions in fostering altruism. There remains a dearth of in-depth knowledge regarding reasons surrounding research participation and the types of altruism displayed in HIV cure-related clinical research. CONCLUSION Lessons learned from various research fields can guide questions which will inform the assessment of altruism in future HIV cure-related research.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kushagra Mathur
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Megan Lo
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Sogol S. Javadi
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- HIV Neurobehavioral Research Program, UCSD, San Diego, CA, USA
| | - Jeff Taylor
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP – PS), Palm Springs, CA, USA
| | - Andy Kaytes
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- AIDS Action Baltimore, Baltimore, MD, CA, USA
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David Smith
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Sara Gianella
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Judith D. Auerbach
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
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A Classifier to Predict Viral Control After Antiretroviral Treatment Interruption in Chronic HIV-1-Infected Patients. J Acquir Immune Defic Syndr 2020; 83:479-485. [PMID: 31904703 DOI: 10.1097/qai.0000000000002281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To construct a classifier that predicts the probability of viral control after analytical treatment interruptions (ATI) in HIV research trials. METHODS Participants of a dendritic cell-based therapeutic vaccine trial (DCV2) constituted the derivation cohort. One of the primary endpoints of DCV2 was the drop of viral load (VL) set point after 12 weeks of ATI (delta VL12). We classified cases as "controllers" (delta VL12 > 1 log10 copies/mL, n = 12) or "noncontrollers" (delta VL12 < 0.5 log10 copies/mL, n = 10) and compared 190 variables (clinical data, lymphocyte subsets, inflammatory markers, viral reservoir, ELISPOT, and lymphoproliferative responses) between the 2 groups. Naive Bayes classifiers were built from combinations of significant variables. The best model was subsequently validated on an independent cohort. RESULTS Controllers had significantly higher pre-antiretroviral treatment VL [110,250 (IQR 71,968-275,750) vs. 28,600 (IQR 18737-39365) copies/mL, P = 0.003] and significantly lower proportion of some T-lymphocyte subsets than noncontrollers: prevaccination CD4CD45RA+RO+ (1.72% vs. 7.47%, P = 0.036), CD8CD45RA+RO+ (7.92% vs. 15.69%, P = 0.017), CD4+CCR5+ (4.25% vs. 7.40%, P = 0.011), and CD8+CCR5+ (14.53% vs. 27.30%, P = 0.043), and postvaccination CD4+CXCR4+ (12.44% vs. 22.80%, P = 0.021). The classifier based on pre-antiretroviral treatment VL and prevaccine CD8CD45RA+RO+ T cells was the best predictive model (overall accuracy: 91%). In an independent validation cohort of 107 ATI episodes, the model correctly identified nonresponders (negative predictive value = 94%), while it failed to identify responders (positive predictive value = 20%). CONCLUSIONS Our simple classifier could correctly classify those patients with low probability of control of VL after ATI. These data could be helpful for HIV research trial design.
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Saberi P, Eskaf S, Sauceda J, Evans D, Dubé K. Perceptions of HIV Virologic Control Strategies Among Younger and Older Age Groups of People Living with HIV in the United States: A Cross-Sectional Survey. AIDS Res Hum Retroviruses 2020; 36:606-615. [PMID: 32368934 DOI: 10.1089/aid.2020.0023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Two HIV virologic control advances are in various stages of development, including long-acting antiretroviral therapy (ART) formulations and strategies aimed at sustained ART-free HIV control. Perceptions of risks and benefits toward HIV virologic control strategies may be different based on an individual's age due to differing experiences of the impacts of the domestic HIV epidemic, altruistic attitudes toward research participation, and general levels of engagement in health care. We examined preferences of HIV virologic control strategies by age groups. In 2018, we conducted a nationwide, online cross-sectional survey to examine differences in HIV virologic control strategies among a sample of people living with HIV who were <50 and ≥50 years of age. From a total of 281 participants, 3 findings were noteworthy: (1) Participants <50 years of age were more likely to be demotivated by perceived social risks (e.g., stigma, discrimination, HIV disclosure, and fear of transmitting HIV during a treatment interruption), compared with those ≥50 years; (2) participants ≥50 years of age were more motivated by altruistic notions compared with those <50 years; and (3) we noted greater desirability of longer long-acting ART and new HIV cure-related strategies among participants <50 years versus those ≥50 years. Our analysis provides a deeper understanding of differences in perceptions among various age groups regarding desirable future ART characteristics, and motivations and barriers to participating in HIV cure-related strategies. Our findings can help inform community engagement and education, and assist researchers in tailoring study design and recruitment efforts to major age groups.
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Affiliation(s)
- Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - Shadi Eskaf
- Department of Environmental Sciences and Engineering, UNC School of Government, Chapel Hill, North Carolina, USA
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health Chapel Hill, Chapel Hill, North Carolina, USA
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Protiere C, Fressard L, Mora M, Meyer L, Préau M, Suzan-Monti M, Lelièvre JD, Lambotte O, Spire B. Characterization of Physicians That Might Be Reluctant to Propose HIV Cure-Related Clinical Trials with Treatment Interruption to Their Patients? The ANRS-APSEC Study. Vaccines (Basel) 2020; 8:vaccines8020334. [PMID: 32585921 PMCID: PMC7350235 DOI: 10.3390/vaccines8020334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 12/25/2022] Open
Abstract
HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment interruptions (ATIs) have become unavoidable. However, the limited benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians’ motivations to propose HCRCT to patients. Between October 2016 and March 2017, 164 French HIV physicians were asked about their level of agreement with four viewpoints regarding HCRCT. A reluctance score was derived from their answers and factors associated with reluctance identified. Results showed the highest reluctance to propose HCRCT was among physicians with a less research-orientated professional activity, those not informing themselves about cure trials through scientific literature, and those who participated in trials because their department head asked them. Physicians’ perceptions of the impact of HIV on their patients’ lives were also associated with their motivation to propose HCRCT: those who considered that living with HIV means living with a secret were more motivated, while those worrying about the negative impact on person living with HIV’s professional lives were more reluctant. Our study highlighted the need to design a HCRCT that minimizes constraints for participants and for continuous training programs to help physicians keep up-to-date with recent advances in HIV cure research.
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Affiliation(s)
- Christel Protiere
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, 13005 Marseille, France; (L.F.); (M.M.); (M.S.-M.); (B.S.)
- Correspondence:
| | - Lisa Fressard
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, 13005 Marseille, France; (L.F.); (M.M.); (M.S.-M.); (B.S.)
| | - Marion Mora
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, 13005 Marseille, France; (L.F.); (M.M.); (M.S.-M.); (B.S.)
| | - Laurence Meyer
- INSERM, U1018, Université Paris-Sud 11, AP-HP, Hôpital de Bicêtre, Département D’épidémiologie, 94270 Le Kremlin-Bicêtre, France;
| | - Marie Préau
- GRePS, Lyon 2 Université, 69676 Bron, France;
| | - Marie Suzan-Monti
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, 13005 Marseille, France; (L.F.); (M.M.); (M.S.-M.); (B.S.)
| | - Jean-Daniel Lelièvre
- INSERM, U955, Equipe 16, Université Paris Est, Faculté de médecine, Vaccine Research Institute, 94000 Créteil, France;
| | - Olivier Lambotte
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, INSERM, U1184, 94270 Le Kremlin-Bicêtre, France;
- Immunology of Viral Infections and Autoimmune Diseases, Université Paris Sud, UMR 1184, 94270 Le Kremlin-Bicêtre, France
- CEA, DSV/iMETI, IDMIT, 92260 Fontenay-aux-Roses, France
| | - Bruno Spire
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, 13005 Marseille, France; (L.F.); (M.M.); (M.S.-M.); (B.S.)
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Who are the persons living with HIV who might refuse to participate in HIV cure-related clinical trials with treatment interruption? AIDS 2020; 34:1095-1099. [PMID: 32287066 DOI: 10.1097/qad.0000000000002530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
: Achieving a HIV cure has become a research priority. As any improvement of knowledge, which could help scientists design new HIV cure-related clinical trials (HCRCT) depends on the risks potential participants are willing to accept, it is important to understand who will agree or refuse to participate and in which proportions. By providing insights into factors associated with reluctance toward HCRCT participation, our results may help clinicians in patient recruitment.
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Dubé K, Auerbach JD, Stirratt MJ, Gaist P. Applying the Behavioural and Social Sciences Research (BSSR) Functional Framework to HIV Cure Research. J Int AIDS Soc 2020; 22:e25404. [PMID: 31665568 PMCID: PMC6820877 DOI: 10.1002/jia2.25404] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine. However, the field has yet to tap into the full potential of behavioural and social sciences research (BSSR). In this article, we apply Gaist and Stirratt’s BSSR Functional Framework to the field of HIV cure research. Discussion The BSSR Functional Framework describes four key research domains: (1) basic BSSR (understanding basic behavioural and social factors), (2) elemental BSSR (advancing behavioural and social interventions), (3) supportive BSSR (strengthening biomedically focused clinical trials), and (4) integrative BSSR (building multi‐disciplinary combination approaches for real‐world implementation). In revisiting and applying the BSSR Functional Framework, we clarify the importance of BSSR in HIV cure research by drawing attention to such things as: how language and communication affect the meaning of “cure” to people living with HIV (PLHIV) and broader communities; how cure affects the identity and social position of PLHIV; counselling and support interventions to address the psychosocial needs and concerns of study participants related to analytical treatment interruptions (ATIs); risk reduction in the course of ATI study participation; motivation, acceptability, and decision‐making processes of potential study participants related to different cure strategies; HIV care providers’ perceptions and attitudes about their patients’ participation in cure research; potential social harms or adverse social events associated with cure research participation; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment. We also discuss the BSSR Functional Framework in the context of ATIs, which involve processes at the confluence of the BSSR domains. Conclusions To move HIV cure regimens through the translational research pathway, attention will need to be paid to both biomedical and socio‐behavioural elements. BSSR can contribute an improved understanding of the human and social dimensions related to HIV cure research and the eventual application of HIV cure regimens. The BSSR Functional Framework provides a way to identify advances, gaps and opportunities to craft an integrated, multi‐disciplinary approach at all stages of cure research to ensure the real‐world applicability of any strategy that shows promise.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Judith D Auerbach
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Stirratt
- Division of AIDS Research (DAR), National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Paul Gaist
- Office of AIDS Research, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD, USA
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Kratka A, Ubel PA, Scherr K, Murray B, Eyal N, Kirby C, Katz MN, Holtzman L, Pollak K, Freedburg K, Blumenthal-Barby J. HIV Cure Research: Risks Patients Expressed Willingness to Accept. Ethics Hum Res 2020; 41:23-34. [PMID: 31743627 DOI: 10.1002/eahr.500035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite doing well on antiretroviral therapy, many people living with HIV have expressed a willingness to accept substantial risks for an HIV cure. To date, few studies have assessed the specific quantitative maximal risk that future participants might take; probed whether, according to future participants, the risk can be offset by the benefits; and examined whether taking substantial risk is a reasonable decision. In this qualitative study, we interviewed 22 people living with HIV and used standard gamble methodology to assess the maximum chance of death a person would risk for an HIV cure. We probed participants' reasoning behind their risk-taking responses. Conventional inductive content analysis was used to categorize key themes regarding decision-making. We found that some people would be willing to risk even death for an HIV cure, and some of their reasons were plausible and went far beyond the health-related utility of an HIV cure. We contend that people's expressed willingness to take substantial risk for an HIV cure should not be dismissed out of hand.
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Affiliation(s)
- Allison Kratka
- Internal medicine resident at Brigham and Women's Hospital
| | - Peter A Ubel
- Professor in the Fuqua School of Business at Duke University
| | | | | | - Nir Eyal
- Directs the Center for Population-Level Bioethics at Rutgers University
| | - Christine Kirby
- Program coordinator in the Center for Health Equity Research at Northern Arizona University
| | - Madelaine N Katz
- MPH candidate at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill
| | - Lisa Holtzman
- Program manager in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health
| | - Kathryn Pollak
- Professor in Population Health Sciences and is the associate director of population sciences in the Duke Cancer Institute at Duke University
| | - Kenneth Freedburg
- Director of the Medical Practice Evaluation Center and is a professor of medicine in the Divisions of General Internal Medicine and Infectious Diseases at Massachusetts General Hospital and Harvard Medical School
| | - Jennifer Blumenthal-Barby
- Associate director and Cullen associate professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine
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Lau JS, Smith MZ, Allan B, Martinez C, Power J, Lewin SR, McMahon JH. Perspectives on Analytical Treatment Interruptions in People Living with HIV and Their Health Care Providers in the Landscape of HIV Cure-Focused Studies. AIDS Res Hum Retroviruses 2020; 36:260-267. [PMID: 31608648 DOI: 10.1089/aid.2019.0118] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Analytical treatment interruptions (ATIs) aim to assess effects of HIV cure-focused interventions, but poses potential risks. Understanding of ATI acceptability among people living with HIV (PLHIV) and their HIV health care providers (HHP) is limited. Two international online surveys for PLHIV and HHP assessed understanding and acceptability of monitoring strategies during ATI. Survey items included the following: frequency of CD4, viral load (VL) and clinical assessment, CD4 and VL threshold to restart antiretroviral therapy (ART), acceptability of detectable viremia during ATI, and potential risks of ATI. Responses were collected from July 2017 to January 2018, and a descriptive analysis was performed. Responses to questions asked in both surveys were compared by χ2 test. Four hundred forty-two completed the PLHIV survey: 22% identified as female, 39% older than 50 years of age, and 64% identified as gay/homosexual/lesbian. Ninety-five percent were on ART, of which 83% reported an undetectable VL. The preferred frequency of CD4, VL, and clinical monitoring during ATI was monthly. Thirty-five percent of respondents preferred VL to remain undetectable during ATI and would not accept any sustained period of viremia, compared to 18% of 144 HHP (p < .01). Having previously interrupted ART predicted preference for VL to remain undetectable during ATI (odds ratio 0.6, p = .05). Both clinicians and PLHIV were concerned about HIV transmission during ATI. Our work demonstrates that PLHIV expectations of ATI in cure-focused clinical trials do not align with current practices, with PLHIV less accepting of viremia during ATI and preferring less frequent monitoring. Clear education messages and careful consent processes need to be developed in relationship to ATIs in HIV cure research.
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Affiliation(s)
- Jillian S.Y. Lau
- Infectious Diseases Unit, Alfred Hospital and Monash University, Melbourne, Australia
| | - Miranda Z. Smith
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Brent Allan
- International Council of AIDS Service Organizations, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations, Ontario, Canada
| | - Cipriano Martinez
- National Association of People Living with HIV Australia, Sydney, Australia
| | - Jennifer Power
- Australian Research Centre for Sex Health and Society, La Trobe University, Melbourne, Australia
| | - Sharon R. Lewin
- Infectious Diseases Unit, Alfred Hospital and Monash University, Melbourne, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - James H. McMahon
- Infectious Diseases Unit, Alfred Hospital and Monash University, Melbourne, Australia
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Dubé K, Eskaf S, Evans D, Sauceda J, Saberi P, Brown B, Averitt D, Martel K, Meija M, Campbell D, Barr L, Kanazawa J, Perry K, Patel H, Luter S, Poteat T, Auerbach JD, Wohl DA. The Dose Response: Perceptions of People Living with HIV in the United States on Alternatives to Oral Daily Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:324-348. [PMID: 31608651 DOI: 10.1089/aid.2019.0175] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There are two concurrent and novel major research pathways toward strategies for HIV control: (1) long-acting antiretroviral therapy (ART) formulations and (2) research aimed at conferring sustained ART-free HIV remission, considered a step toward an HIV cure. The importance of perspectives from people living with HIV on the development of new modalities is high, but data are lacking. We administered an online survey in which respondents selected their likelihood of participation or nonparticipation in HIV cure/remission research based on potential risks and perceived benefits of these new modalities. We also tested the correlation between perceptions of potential risks and benefits with preferences of virologic control strategies and/or responses to scenario choices, while controlling for respondent characteristics. Of the 282 eligible respondents, 42% would be willing to switch from oral daily ART to long-acting ART injectables or implantables taken at 6-month intervals, and 24% to a hypothetical ART-free remission strategy. We found statistically significant gender differences in perceptions of risk and preferences of HIV control strategies, and possible psychosocial factors that could mediate willingness to switch to novel HIV treatment or remission options. Our study yielded data on possible desirable product characteristics for future HIV treatment and remission options. Findings also revealed differences in motivations and preferences across gender and other sociodemographic characteristics that may be actionable as part of research recruitment efforts. The diversity of participant perspectives reveals the need to provide a variety of therapeutic options to people living with HIV and to acknowledge their diverse experiential expertise when developing novel HIV therapies.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
| | - Shadi Eskaf
- Environmental Finance Center, UNC School of Government, Chapel Hill, North Carolina
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Dawn Averitt
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Krista Martel
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Maria Meija
- The Well Project Community Advisory Board, Tamarac, Florida
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee Representative, Baltimore, Maryland
| | - John Kanazawa
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kelly Perry
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Hursch Patel
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Stuart Luter
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Tonia Poteat
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- UNC Department of Social Medicine, School of Medicine, Chapel Hill, North Carolina
| | - Judith D. Auerbach
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina, Chapel Hill, North Carolina
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Power J, Dowsett GW, Westle A, Tucker JD, Hill S, Sugarman J, Lewin SR, Brown G, Lucke J. The significance and expectations of HIV cure research among people living with HIV in Australia. PLoS One 2020; 15:e0229733. [PMID: 32130262 PMCID: PMC7055878 DOI: 10.1371/journal.pone.0229733] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/12/2020] [Indexed: 01/20/2023] Open
Abstract
Most people living with HIV (PLHIV) with reliable access to antiretroviral treatment (ART) have a life expectancy similar to uninfected populations. Despite this, HIV can negatively affect their social and psychological wellbeing. This study aimed to enhance understanding of the expectations PLHIV hold for HIV cure research and the implications this has for HIV cure research trials. We interviewed 20 Australian PLHIV about their expectations for HIV cure research outcomes and the impact a potential cure for HIV may have on their everyday lives. Data were analysed thematically, using both inductive and deductive approaches. The significance of a cure for HIV was expressed by participants as something that would offer relief from their sense of vigilance or uncertainty about their health into the future. A cure was also defined in social terms, as alleviation from worry about potential for onward HIV transmission, concerns for friends and family, and the negative impact of HIV-related stigma. Participants did not consider sustained medication-free viral suppression (or remission) as a cure for HIV because this did not offer certainty in remaining virus free in a way that would alleviate these fears and concerns. A cure was seen as complete elimination of HIV from the body. There is an ethical need to consider the expectations of PLHIV in design of, and recruitment for, HIV cure-related research. The language used to describe HIV cure research should differentiate the long-term aspiration of achieving complete elimination of HIV from the body and possible shorter-term therapeutic advances, such as achieving medication free viral suppression.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Gary W. Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Andrew Westle
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joseph D. Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharon R. Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
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42
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Peluso MJ, Dee L, Campbell D, Taylor J, Hoh R, Rutishauser RL, Sauceda J, Deeks SG, Dubé K. A collaborative, multidisciplinary approach to HIV transmission risk mitigation during analytic treatment interruption. J Virus Erad 2020; 6:34-37. [PMID: 32175090 PMCID: PMC7043899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Analytic treatment interruptions (ATIs) are currently the standard for assessing the impact of experimental interventions aimed at inducing sustained antiretroviral therapy (ART)-free remission in trials related to HIV cure. ATIs are associated with substantial risk to both study participants and their sexual partner(s). Two documented HIV transmissions occurring in the context of ATIs have been recently reported, but recommendations for mitigating the risk of such events during ATIs are limited. We outline a practical approach to risk mitigation during ATI studies and describe strategies we are utilising in an upcoming clinical trial that may be applicable to other centres.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA,Corresponding author: Michael J Peluso,
995 Potrero Ave, Building 80,
San Francisco,
CA94110,
USA
| | - Lynda Dee
- AIDS Action Baltimore,
Baltimore,
MD,
USA,amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Delaney AIDS Research Enterprise Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA
| | - Danielle Campbell
- amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Delaney AIDS Research Enterprise Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA,Charles R Drew University of Medicine and Science, Los Angeles,
CA,
USA
| | - Jeff Taylor
- amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA,University of California, San Diego Antiviral Research Center Community Advisory Board,
San Diego,
CA,
USA,HIV+Aging Research Project, Palm Springs,
CA,
USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA
| | | | - John Sauceda
- Center for AIDS Prevention Studies,
UCSF,
San Francisco,
CA,
USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
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43
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Protiere C, Arnold M, Fiorentino M, Fressard L, Lelièvre JD, Mimi M, Raffi F, Mora M, Meyer L, Sagaon‐Teyssier L, Zucman D, Préau M, Lambotte O, Spire B, Suzan‐Monti M. Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS-APSEC study: a discrete choice experiment. J Int AIDS Soc 2020; 23:e25443. [PMID: 32077248 PMCID: PMC7048214 DOI: 10.1002/jia2.25443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the advent of HIV cure-related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well-designed informed consent. METHODS Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade-offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu-type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. RESULTS Apart from severe SE - the most decisive attribute in both groups - PLWH and physicians made different trade-offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades-offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade-offs and utilities regarding HCRCT. CONCLUSIONS Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.
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Affiliation(s)
- Christel Protiere
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | | | - Marion Fiorentino
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Lisa Fressard
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Jean D Lelièvre
- INSERMCréteilFrance
- Faculté de médecineUniversité Paris EstCréteilFrance
- Vaccine Research InstituteCréteilFrance
| | - Mohamed Mimi
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - François Raffi
- Department of Infectious DiseasesHotel‐Dieu Hospital ‐ INSERM CIC 1413Nantes University HospitalNantesFrance
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Laurence Meyer
- Département d'épidémiologie, INSERM, U1018Université Paris‐Sud 11AP‐HPHôpital de BicêtreLe Kremlin‐BicêtreFrance
| | - Luis Sagaon‐Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - David Zucman
- Hôpital Foch, service de médecine interneSuresnesFrance
| | | | - Olivier Lambotte
- Assistance Publique ‐ Hôpitaux de ParisHôpital BicêtreService de Médecine Interne et Immunologie cliniqueLe Kremlin‐BicêtreFrance
- Immunology of Viral Infections and Autoimmune DiseasesINSERM, U1184Le Kremlin‐BicêtreFrance
- UMR 1184Université Paris SudLe Kremlin‐BicêtreFrance
- CEADSV/iMETIIDMITFontenay‐aux‐RosesFrance
| | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Marie Suzan‐Monti
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleAix Marseille UnivMarseilleFrance
- ORS PACAObservatoire régional de la santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
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Peluso MJ, Dee L, Campbell D, Taylor J, Hoh R, Rutishauser RL, Sauceda J, Deeks SG, Dubé K. A collaborative, multidisciplinary approach to HIV transmission risk mitigation during analytic treatment interruption. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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45
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Impact of analytical treatment interruption on the central nervous system in a simian-HIV model. AIDS 2019; 33 Suppl 2:S189-S196. [PMID: 31789818 DOI: 10.1097/qad.0000000000002270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE(S) Analytical treatment interruption (ATI) studies are often used to evaluate potential HIV cure strategies. This study was conducted to determine the impact of ATI on simian-HIV (SHIV) infection in the central nervous system. DESIGN Animal study. METHODS Nine rhesus macaques were inoculated with SHIV-1157ipd3N4. Antiretroviral therapy (ART) was administered from week 2 to 18. At week 18, four animals were euthanized (no-ATI-group) and five underwent ATI (ATI-group) and were euthanized at 12 weeks post viral rebound. Plasma and cerebrospinal fluid (CSF) SHIV-RNA, markers of inflammation and brain CD3+, CD68+/CD163+ and RNA+ cells were measured. RESULTS All nine animals were SHIV-infected, with median pre-ART plasma and CSF SHIV-RNA of 6.2 and 3.6 log10copies/ml. Plasma and CSF IL-15, monocyte chemoattractant protein-1, IFN-γ-induced protein-10 and neopterin increased postinfection. ART initiation was associated with rapid and complete suppression of plasma viremia and reductions in plasma and CSF IL-15, IFN-γ-induced protein-10, neopterin and CSF monocyte chemoattractant protein-1. Median time to plasma viral rebound was 21 days post-ATI. At 12 weeks postrebound, CSF SHIV-RNA was undetectable and no increases in plasma and CSF markers of inflammation were found. Higher numbers of CD3+ and CD68+/CD163+ cells were seen in the brains of 3/5 and 1/5 animals, respectively, in the ATI-group when compared with no-ATI-group. SHIV-RNA+ cells were not identified in the brain in either group post-ATI. CONCLUSION ATI in macaques that initiated ART during early SHIV-1157ipd3N4 infection was associated with mild, localized T-cell infiltrate in the brain without detectable SHIV-RNA in the brain or CSF, or elevation in CSF soluble markers of inflammation.
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46
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Fehér C, Leal L, Plana M, Climent N, Crespo Guardo A, Martínez E, Castro P, Díaz-Brito V, Mothe B, López Bernaldo De Quirós JC, Gatell JM, Aloy P, García F. Virological Outcome Measures During Analytical Treatment Interruptions in Chronic HIV-1-Infected Patients. Open Forum Infect Dis 2019; 6:ofz485. [PMID: 32128329 PMCID: PMC7047957 DOI: 10.1093/ofid/ofz485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background Analytical treatment interruptions (ATIs) are essential in research on HIV cure. However, the heterogeneity of virological outcome measures used in different trials hinders the interpretation of the efficacy of different strategies. Methods We conducted a retrospective analysis of viral load (VL) evolution in 334 ATI episodes in chronic HIV-1-infected patients collected from 11 prospective studies. Quantitative (baseline VL, set point, delta set point, VL, and delta VL at given weeks after ATI, peak VL, delta peak VL, and area under the rebound curve) and temporal parameters (time to rebound [TtR], set point, peak, and certain absolute and relative VL thresholds) were described. Pairwise correlations between parameters were analyzed, and potential confounding factors (sex, age, time of known HIV infection, time on ART, and immunological interventions) were evaluated. Results The set point was lower than baseline VL (median delta set point, –0.26; P < .001). This difference was >1 log10 copies/mL in 13.9% of the cases. The median TtR was 2 weeks; no patients had an undetectable VL at week 12. The median time to set point was 8 weeks: by week 12, 97.4% of the patients had reached the set point. TtR and baseline VL were correlated with most temporal and quantitative parameters. The variables independently associated with TtR were baseline VL and the use of immunological interventions. Conclusions TtR could be an optimal surrogate marker of response in HIV cure strategies. Our results underline the importance of taking into account baseline VL and other confounding factors in the design and interpretation of these studies.
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Affiliation(s)
- Csaba Fehér
- Institute for Research in Biomedicine (IRB Barcelona), the Barcelona Institute for Science and Technology, Barcelona, Spain.,Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lorna Leal
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Nuria Climent
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alberto Crespo Guardo
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Esteban Martínez
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Vicens Díaz-Brito
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain
| | - Beatriz Mothe
- IrsiCaixa AIDS Research Institute, Badalona, Spain.,Infectious Diseases Department, Hospital Germans Trias i Pujol, Badalona, Spain.,University of Vic - Central University of Catalonia, Vic, Spain
| | - Juan Carlos López Bernaldo De Quirós
- HIV/Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Josep María Gatell
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,ViiV Healthcare, Tres Cantos, Spain
| | - Patrick Aloy
- Institute for Research in Biomedicine (IRB Barcelona), the Barcelona Institute for Science and Technology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Felipe García
- Infectious Diseases Department, Hospital Clinic of Barcelona - HIVACAT, University of Barcelona, Barcelona, Spain.,Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) - HIVACAT, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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47
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Fiorentino M, Protière C, Sagaon-Teyssier L, Mimi M, Fressard L, Arnold MP, Lambotte O, Barbot J, Fainzang S, Meyer L, Goujard C, Préau M, Spire B, Suzan-Monti M. What is the effect of self-identified HIV activism in willingness to participate in HIV cure-related clinical trials? Results from the ANRS-APSEC study. J Virus Erad 2019; 5:152-162. [PMID: 31700661 PMCID: PMC6816119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Enrolling people living with HIV with undetectable viral load into HIV cure-related clinical trials (HCRCT) is challenging. Few data are currently available about the individual factors that influence willingness to participate in HCRCT (WPHCRCT). We hypothesised that WPHCRCT would be more frequent among people living with HIV considering themselves HIV activists. The objective of this study was to investigate the individual characteristics associated with both WPHCRCT and self-identification as an HIV activist. METHODS The study enrolled 195 long-term ART-treated and virologically suppressed people living with HIV, followed-up in 19 French HIV services, 2016-2017. A Bayesian model averaging approach was used to assess correlates of both outcomes i.e. WPHCRCT and self-identified HIV activism. RESULTS WPHCRCT was reported by 43% of participants and was positively associated with self-identification as an HIV activist (adjusted odds ratio [aOR] 2.90 95% confidence interval [CI] 2.17-3.63], P<0.05) and self-confidence as an HIV positive person (aOR 1.17, 95% CI 0.99-1.35, P<0.1). Self-identified HIV activists (56% of participants) were more likely to have a higher 'relationship with others' score using the post-traumatic growth inventory (aOR 1.10, 95% CI 0.99-1.20, P<0.1), to obtain information about HIV from a greater number of sources (aOR 1.35 [95% CI 1.00-1.68], P<0.1), and to feel greatly affected by mandatory daily treatment (aOR 2.15, 95% CI 1.27-3.03, P<0.1). All associations had relative importance weight>0.75, indicating strong evidence. CONCLUSIONS WPHCRCT is strongly related to HIV activism, and also to positive psychosocial characteristics as a person living with HIV, especially regarding relationships with others. The desire to contribute to the fight against HIV for the sake of the HIV community and society should be taken into account to improve participation in upcoming HCRCT.
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Affiliation(s)
- Marion Fiorentino
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France,Corresponding author: Marion Fiorentino,
SESSTIM Faculté de médecine,
27 bd Jean Moulin,
13005Marseille,
France
| | - Christel Protière
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
| | - Luis Sagaon-Teyssier
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
| | - Mohamed Mimi
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
| | - Lisa Fressard
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
| | | | - Olivier Lambotte
- INSERM, U1184, Université Paris-Sud , Hôpital de Bicêtre, Service de Médecine Interne,
Le Kremlin-Bicêtre,
France
| | - Janine Barbot
- INSERM, Centre d’étude des mouvements sociaux,
Paris,
France
| | - Sylvie Fainzang
- Centre for Research in Medicine, Science, Health, Mental Health, and Society,
Villejuif,
France
| | - Laurence Meyer
- INSERM, U1018, Université Paris-Sud, Hôpital de Bicêtre, Department of Epidemiology,
Le Kremlin-Bicêtre,
France
| | - Cécile Goujard
- INSERM, U1018, Université Paris-Sud, Hôpital de Bicêtre, Department of Epidemiology,
Le Kremlin-Bicêtre,
France
| | | | - Bruno Spire
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
| | - Marie Suzan-Monti
- Aix Marseille University, INSERM, IRD, SESSTIM, Economic and Social Health Sciences and Medical Information Processing,
Marseille,
France,Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille,
France
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Fiorentino M, Protière C, Sagaon-Teyssier L, Mimi M, Fressard L, Arnold M, Lambotte O, Barbot J, Fainzang S, Meyer L, Goujard C, Préau M, Spire B, Suzan-Monti M. What is the effect of self-identified HIV activism in willingness to participate in HIV cure-related clinical trials? Results from the ANRS-APSEC study. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30045-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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Abstract
Purpose of review Several promising experimental pathways exist for long-term control of HIV in the absence of antiretroviral therapy (HIV ‘remission’) and are now being tested in early clinical studies. These studies can be invasive and pose a host of distinctive risks to participants, as well as to nonparticipants, especially to participants’ fetuses, and sexual partners. Recent findings Ethical analyses of these studies have mainly focused on the risks to study participants. They recommend, and some investigators implement, procedures to mitigate risks for participants or to offset them with direct, indirect, and nonmedical benefits. They also suggest ways to keep participants’ consent highly voluntary and informed. Rarely do ethicists propose keeping the social value of studies high. Of these recommended responses, only the latter, rarer proposals help address the risk to nonparticipants, as would some novel ways to address that risk. Summary HIV remission studies pose a number of ethical dilemmas. Many current investigative approaches put the participant at significant risk, but well established guidelines exist for mitigating this risk. Ethical issues that are not being fully addressed include risk to nonparticipants and the need to consider the societal value of studies, for example, their prospective impact on the global HIV burden. Video abstract
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50
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Lau JS, Smith MZ, Lewin SR, McMahon JH. Clinical trials of antiretroviral treatment interruption in HIV-infected individuals. AIDS 2019; 33:773-791. [PMID: 30883388 DOI: 10.1097/qad.0000000000002113] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
: Despite the benefits of antiretroviral therapy (ART) for people living with HIV, there has been a long-standing research interest in interrupting ART as a strategy to minimize adverse effects of ART as well as to test interventions aiming to achieve a degree of virological control without ART. We performed a systematic review of HIV clinical studies involving treatment interruption from 2000 to 2017 to describe the differences between treatment interruption in studies that contained and didn't contain an intervention. We assessed differences in monitoring strategies, threshold to restart ART, duration and adverse outcomes of treatment interruption, and factors aimed at minimizing transmission. We found that treatment interruption has been incorporated into 159 clinical studies since 2000 and is increasingly being included in trials to assess the efficacy of interventions to achieve sustained virological remission off ART. Great heterogeneity was noted in immunological, virological and clinical monitoring strategies, as well as in thresholds to recommence ART. Treatment interruption in recent intervention studies were more closely monitored, had more conservative thresholds to restart ART and had a shorter treatment interruption duration, compared with older treatment interruption studies that didn't include an intervention.
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