28 Oct 2020
Leveraging the advances for HIV for COVID-19
Here is the next installment of our column looking at what previous pandemics can teach us about COVID-19.
This article was first published in The Lancet. Full author list below.
The COVID-19 pandemic has led to accelerated research efforts globally and highlighted the importance of community engagement and leadership in the COVID-19 response. To achieve these objectives, partnerships between science, government, and affected communities are crucial, but building these rapidly presents major challenges. In the past months, we have also seen how advances in confronting the global HIV epidemic have had a positive impact on the COVID-19 response.
Accessible, rapid point-of-care diagnostics were developed to increase uptake of HIV testing and shift to a model of self-testing and community-led programmes. These technologies are allowing for rapid implementation of diagnostic capacity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR testing in low-income and middle-income countries (LMICs).
Strategies used to isolate and manufacture broadly neutralising antibodies for HIV have been applied to SARS-CoV-2 and are entering clinical trials.
Although potential SARS-CoV-2 antivirals are still only in early stage research and development, eventually, combination antivirals might have a role for treatment and prevention of COVID-19, as pioneered for HIV.
Novel vaccine platforms, including nucleic acid-based vaccines such as DNA and RNA and live vectors, again developed for HIV, are now in phase 2 and 3 clinical trials for COVID-19.
As with HIV, COVID-19 has had a major impact on women, with higher risks of infection for women in some settings, such as health care, and a disproportionate economic impact on women as a consequence of school closures and women being primary caregivers.
Furthermore, given the high risk of infection and adverse outcomes from COVID-19 in Black and minority ethnic groups and other vulnerable populations, the lessons of community empowerment and advocacy from HIV could help inform the response to COVID-19. Lessons learnt from scaling up antiretroviral therapy to more than 25 million people, including those with limited access to health care, and specifically to engage women will be applicable to rolling out any potential COVID-19 vaccines and treatments. If COVID-19 vaccines are eventually deployed, there are likely to be challenges with mass vaccination programmes but empowering marginalised groups and using a human rights approach will be central to success.
The accelerated agenda of COVID-19 research will benefit the future of HIV testing, treatment, and prevention. There will be a continued expansion of the research infrastructure needed to work with both viruses, specifically high containment laboratories and animal facilities. Diagnostic, antiviral, and vaccine companies are involved in COVID-19 research, including companies that have not previously engaged in viral infectious disease.
Given the scale of testing needed in the COVID-19 pandemic, the introduction of testing capabilities in LMICs could also be used for HIV and tuberculosis.
These overlapping epidemics represent an opportunity to extend cross-disciplinary research into the integrated service delivery for HIV, tuberculosis, and COVID-19, and aim to achieve sustained benefits of prevention and treatment.
Finally, the accelerated pathways to develop COVID-19 vaccines resulting in clinical trials of multiple candidates within months of discovery of SARS-CoV-2 should be applied to challenges such as developing an HIV vaccine.
In the short term, there have been some adverse impacts of COVID-19 on HIV research and services, as for many other diseases. Nearly all HIV clinical trials globally have halted or slowed enrolment to appropriately maximise safety for participants, and health services have seen reductions in screening, laboratory monitoring, and collections of medications, highlighting the fragility of health systems, especially in LMICs. Many HIV-focused laboratory-based research groups have moved to work on SARS-CoV-2. Finally, a decrease in resourcing for infectious diseases research, together with the economic impacts of COVID-19, could lead to less funding for HIV research and ongoing disruption of the provision of HIV and related services.
Yet the transformative advances that are being achieved in the response to COVID-19 could be harnessed to establish strategic and strong collaborations for the HIV and COVID-19 scientific communities. The International AIDS Society (IAS) achieved this at the virtual IAS COVID-19 Conference in July, 2020. A similar format will be used in future conferences related to HIV prevention and COVID-19 vaccines, such as the HIV Research for Prevention Conference in early 2021. Incentives are also needed for the public, private, and philanthropic sectors to maintain their interest and leadership in developing solutions for infectious diseases, not only during a pandemic but also during interpandemic periods. Finally, we should ensure that the global health alliances that are currently forming in relation to COVID-19 vaccines, such as the COVID-19 Vaccine Global Access Facility, are maintained to deliver solutions to ongoing global health challenges.
International solidarity and collaboration have been the hallmarks of the HIV response globally. We will need even more widespread collaborative efforts to end the COVID-19 pandemic. Concerns about access to potential COVID-19 vaccines and therapeutics are highly relevant for LMICs and for vulnerable populations globally.
Arguably, the most important lesson of the HIV response is that no country could go it alone in bringing this deadly virus to its current state of a chronic treatable condition. We need to heed this lesson to avoid nationalistic responses that jeopardise global access to solutions and cannot succeed against a global pandemic.
Dr James McMahon, Infectious Diseases Physician and Head of Clinical Research, The Alfred and Monash University
Professor Jennifer Hoy, Director of HIV Medicine, The Alfred
Professor Adeeba Kamarulzaman, Dean of the Faculty of Medicine, University of Malaya
Professor Linda-Gail Bekker, Deputy-Director, Desmond Tutu HIV Centre
Professor Chris Beyrer, Desmond M Tutu Professor of Public Health and Human Rights, John Hopkins Bloomberg School of Public Health
Professor Sharon Lewin, Doherty Institute Director
For full lists of references and funding declarations, please go to the article on The Lancet website.