Current challenges and recent advances in the search for a cure for <scp>HIV</scp>

Jones, R. Brad

doi:10.1002/jia2.25248

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Achieving a HIV cure has become a research priority, implying the need for HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment inter ruption (ATI) [1][2][3][4][5][6][7][8][9][10][11][12][13]. In the current context of modern, well tolerated, combined antiretroviral therapy (cART), clinical and biological HCRCT-related issues cannot be disconnected from associated ethical questions or from the consequences on the daily lives of persons living with HIV (PLWH) who will participate in HCRCT [14][15][16][17][18][19][20][21][22][23][24][25][26]. As any improvement in knowledge regarding future HCRCT depends on the risks that potential participants are willing to accept, it is important not only to document their preferences for different candidate HCRCT types but also to acquire a greater understanding about which PLWH would be more likely to agree or to refuse to participate, and in which proportions [15,[26][27][28][29].…”

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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?

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Fiorentino

Sow

et al. 2020

Aids

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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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confidence: 99%

“…We performed a multivariable linear regression to deterrnine factors associated with reluctance to partici pate in HCRCT. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] years.…”

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confidence: 99%

Who are the persons living with HIV who might refuse to participate in HIV cure-related clinical trials with treatment interruption?

Protière

Fiorentino

Sow

et al. 2020

Aids

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“…Although one would expect the preferred choice to be a hypothetical HCRCT design promising the fewest severe and moderate SE for the best outcome (six to twelve months ATI in 10% of patients), such a trial cannot exist in real life. Physicians from the scientific committee described four candidate HCRCT aimed at achieving a functional cure (long-term control of HIV in the absence of ART), as the only current sterilizing cure (elimination of all HIV-infected cells) option is allogeneic bone marrow transplant [2,5,[47][48][49][50][51][52][53][54][55][56]. We described the four HCRCT (latent reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy) according to attributes and levels (Table S3).…”

Section: Discrete Choice Experimentsmentioning

confidence: 99%

Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS‐APSEC study: a discrete choice experiment

et al. 2020

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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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“…However, in the current context of modern, well-tolerated cART, where new treatment regimens reducing administration frequency are being introduced, clinical and biological-related issues to HCRCT cannot be disconnected from associated ethical questions or, indeed, from the consequences on the daily lives of PLWH who will participate in HCRCT [17][18][19][20][21][22][23][24][25][26][27][28]. The limited direct benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians' motivations to propose participation in HCRCT with ATI to their patients [21].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Physicians That Might Be Reluctant to Propose HIV Cure-Related Clinical Trials with Treatment Interruption to Their Patients? The ANRS-APSEC Study

et al. 2020

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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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Current challenges and recent advances in the search for a cure for HIV

Cited by 5 publications

References 20 publications

Who are the persons living with HIV who might refuse to participate in HIV cure-related clinical trials with treatment interruption?

Who are the persons living with HIV who might refuse to participate in HIV cure-related clinical trials with treatment interruption?

Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS‐APSEC study: a discrete choice experiment

Characterization of Physicians That Might Be Reluctant to Propose HIV Cure-Related Clinical Trials with Treatment Interruption to Their Patients? The ANRS-APSEC Study

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