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Summary of the Report from the IAS HIV Cure and Cancer Forum
In its 15th year, the IAS initiative Cure Towards an HIV Cure, held its forum prior to the IAS conference. This year the forum expanded its attention to Cancer given the similarities between the fields and limited formal collaboration. Many immunological therapies used for Cancer treatment may also have a role in HIV Cure. As our HIV patients age with suppressed HIV viremia they are experiencing more cancer. Cancer and Persistence of HIV share many features and goals of treatment so that a shared approach to research will only enhance outcomes for both groups and especially for HIV patients with cancer. This latter group are currently serving as an “observational cohort” as we try to understand the effects of immune checkpoint blockers – both efficacy and adverse effects, short and long term – in people living with HIV and its associated additional immune dysfunction. Cell surface marker CD32a on CD4 cells has now been recognised as a potential marker for HIV DNA levels. The concept of measurement of residual disease burden after treatment is being borrowed from oncology to aid in the understanding of achieving durable remission. Focus on the change in approach to treatment of cancer from drugs targeting cancer cells to the approach now of targeting the host’s own immune cells to kill the cancer cells. Understanding of how anti-cancer drugs affect the HIV reservoir was progressed, as was comparisons of the effects of immunotherapy for cancer and in HIV. The class and availability of different “immune checkpoint inhibitors” is exploding in cancer treatment, and as HIV patients with cancer start to receive these drugs for their cancer, the effects on latency reversal of HIV are being carefully documented. Interferons are being revisited, effects of stem cell transplants and gene therapy to improve the immune response to cancer are also being explored – but all early days and case reports in the main. One of the most important sessions was a round table discussion on clinical trial design once the safest better candidates have been identified – protocols with a common trial design, agreed endpoints (most likely composite) and biomarker measurement, need to be established. Access has been identified as a major consideration, community engagement vital, understanding of how analytical treatment interruptions will be used and viewed by participants and the financial “toxicity” of HIV Cure were identified. We continue to make strides towards our ultimate goal.