World AIDS Day

To mark World AIDS Day on 1 December, Dr Julie Fox spoke to us about her pioneering research on HIV prevention, the effects of the COVID-19 pandemic, and her advice to staff and students.

HIV (Human Immunodeficiency Virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. AIDS (Acquired Immune Deficiency Syndrome) is the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus.

While AIDS cannot be transmitted from one person to another, the HIV virus can.

There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life, and to not be infectious to pass the virus on.

To mark World AIDS Day on 1 December, KHP’s Deputy Head of Communications Joe Sparks spoke to Dr Julie Fox - lead of the HIV clinical trials unit at Guy’s and St Thomas’ NHS Foundation Trust (NHS FT) and Reader in HIV Infection in the School of Immunology & Microbial Sciences at King's College London.

Joe: Hi Julie, please can you tell us some of the big projects you’re working on?

Julie: We currently are working on two main areas.

On HIV prevention we have recently shown that providing post exposure prophylaxis (PEP) to people at risk of HIV to take at home, can mean that it is taken quickly after sex which makes it work better. We are now working on ways to take both PrEP and PEP more effectively and started from home rather than waiting to see someone at a clinic or hospital.

When it comes to a HIV cure, although antiretroviral therapy (ART) is amazing, people infected are still hoping for a cure. Stigma remains and lifelong treatment is both expensive and difficult to maintain. The RIO Trial is a global pioneer, we’re undertaking the largest randomised control study of long acting broadly, neutralising antibodies in the world. Volunteers are randomised to either broadly neutralising antibody (bNAB) or placebo, and then stop ART to see if the virus comes back. It is funded by the Bill and Melinda Gates Foundation. We’re really hoping to be able to present results in 2024. The trial is part of our longstanding UK wide collaboration called CHERUB, which is aiming to cure HIV.

Joe: You were heavily involved during the first year of the COVID-19 pandemic to look at the effectiveness of the vaccines on people living with HIV. Can you tell us more about that?

Julie: The research we led on in COVID-19 showed that the AstraZeneca vaccine COVID-19 vaccine was equally effective in people living with HIV compared to people without HIV. This meant that you didn't need an HIV test before a COVID-19 vaccine and no change had to be made in the dose or the vaccine interval in people with HIV.

The AstraZeneca vaccine was trialled through a big international multi-centre study called COV 002. We secured independent funding to look at the vaccine’s effectiveness in people living with HIV and recruited 60 patients, half from Guy’s and St Thomas’ NHS FT and the remainder from Imperial NHS FT.

The results from our 60 HIV positive people were compared to the thousands of volunteers taking part in the main study which made our findings extremely powerful.

Joe: Can you give us an idea of the impact this made?

Julie: In the very early stages of the pandemic, there was a lot we didn’t know about the impact of a COVID-19 infection on someone living with HIV. For instance - whether people with HIV were more likely to get COVID-19 or if they did get it, were they more likely to get sick.

This resulted in people given different messages about whether to shield or not. In some cases, those told to shield ended up having to disclose their HIV status to employers, colleagues, and friends when they would have preferred not to. This led to a lot of anxiety. There was real risk of inadvertent significant social harm at that time, of course completely accidental as a result of trying to protect patients’ health.

The same was true for vaccination. Those people with low CD4 (white blood cell) counts needed to be prioritised for early and frequent vaccination, but our research showed that if someone was on ART then they need the same vaccine interval as everyone else.

Ultimately our work found you didn’t need to treat everyone living with HIV as a vulnerable population. There are of course some who aren't on treatment or who had a very low CD4 count who would be classified as at higher risk. But around 90% of people living with HIV didn't need anything different.

Joe: What impact is your work having internationally?

Julie: I’ve been the Lead Investigator for CHAPS (Combined HIV Adolescent Prevention Study) which is an HIV prevention programme in South Africa, Uganda, and Zimbabwe. AIDS-related deaths in adolescents have trebled since 2000 and is the leading cause of mortality in adolescents worldwide.

We found that young people were very willing to take PrEP if available. Young women preferred daily PREP, whereas young men preferred to take PrEP only around the time they had sex. Both forms work well, but people have to be counselled how to take it appropriately. Mental health problems and sexual violence were common but did not affect attitudes around PrEP. A clinical trial then showed that for men, taking a double dose of PrEP led to a high level of protection from HIV across foreskin tissue.

We are also working on the African-led and European-supported PrEPVacc HIV prevention study which is a joint HIV vaccine and PrEP trial in HIV-negative people who report behaviours that put them at increased risk of catching HIV, in South Africa, Uganda and Tanzania. This trial has almost completed the recruitment of at least 1,450 participants and tests two different experimental combination vaccine regimens as well as two different types of PrEP. This is one of just two HIV vaccine efficacy trials currently underway globally.

The COVID-19 pandemic has meant that all our research has been incredibly difficult to carry out, but things now seem to be returning to normal.

Joe: Finally on World Aids Day – what message would you like staff and students to take away?

Julie: HIV is a fully treatable condition I would encourage everyone to get tested and know your status. For people at risk of HIV take PrEP and for those with HIV take ART regularly. This means that HIV transmissions will stop and people with HIV can have a normal life expectance.

HIV testing is provided to anyone free of charge on the NHS. Many clinics can give you the result on the same day. Home testing and home sampling kits are also available. You can find details of services on the NHS website. The earlier HIV is diagnosed, the earlier you can start treatment, boost your immune system, and stop being infectious to others.