Confronting the
HIV epidemic

Emory's leadership in the fight against HIV spans decades, from public health research to pioneering breakthroughs in treatments and the search for a vaccine.

Emory physicians, scientists, and educators have played a key role in HIV/AIDS discovery and treatment from the earliest days of the epidemic. In fact, Emory researchers invented HIV/AIDS drugs currently used by more than 94 percent of US patients and thousands more globally.

The Emory Center for AIDS Research, continuously designated and funded by the National Institutes of Health (NIH), remains committed to decreasing HIV incidence, improving the well-being of infected individuals, training the next generation of researchers and clinical leaders, and ultimately finding a vaccine and cure for HIV.

That focus continued undaunted during the past year, as Emory public health experts announced key findings about the communities hardest hit by HIV and a consortium of Emory researchers was awarded more than $35 million to pursue an effective, lasting vaccine.

Where HIV hits hardest

In May 2016, researchers at Rollins School of Public Health published a study finding that while about 15 percent of gay and bisexual men in the US have HIV, the rates of infected men who have sex with men (MSM) in some Southern cities are twice as high as the national average.

Although the South is generally known as a hot zone for HIV/AIDS, the Emory study, led by Eli Rosenberg, assistant professor of epidemiology at Rollins, was the first to break down HIV rates for MSM by state, county, and metropolitan area. It wasn't a simple task.

“The US Census does not capture MSM or gay men, so we couldn’t calculate the rates,” says Rosenberg. “The CDC had produced a national number [of infected MSM], but there was no subnational number. Everything below that was darkness. When we wanted to look at states and counties, we were at a loss.”

Rosenberg’s team’s solution was to collect data from the Centers for Disease Control and Prevention (CDC) on nationwide HIV infection and divide those numbers by MSM population estimates from another recently published Emory study.

The results were staggering. According to Rosenberg’s research, six US states exceeded the national average of 15 percent of MSM living with HIV in 2012 — and all of them (including Georgia) were in the South. Of the top 25 metro areas in terms of prevalence, 21 were south of the Ohio River.

"These refined results are an additional tool for regional and local public health action and provide further evidence for the need to prioritize HIV prevention efforts for MSM and particularly for MSM living in the South," he says.

women working in lab

Collaborating
for a cure

Amara and Hunter in research lab
Rama Amara (left) and Eric Hunter are coprincipal investigators of the Emory Consortium for Innovative AIDS Research in Non-Human Primates.

As Rosenberg and his team are pinpointing where HIV is striking hardest so that they can better target prevention and treatment, other Emory researchers are making strides toward improving that treatment — and moving closer to a cure.

Less than a month after the Rollins epidemiology study was released, the National Institutes of Health announced that it was awarding a five-year, $35.6 million grant to the Emory Consortium for Innovative AIDS Research in Nonhuman Primates (CIAR-NHP). The consortium is a collaboration of scientists and investigators in an array of disciplines — from immunology to pathology to biostatistics — who have come together with the common goal of developing an effective, lasting vaccine for HIV.

The task begins at the Emory Vaccine Center and Yerkes National Primate Research Center, where researchers are working with simian immunodeficiency virus (SIV), HIV’s nonhuman primate cousin, and other SIV/HIV hybrids to simulate the virus in people.

“We have to be tackling this from multiple angles," says Eric Hunter, professor of pathology at the School of Medicine and the Emory Vaccine Center and the grant’s coprincipal investigator. "This grant is going to give us the resources to really explore approaches that are going to move the vaccine field forward, because it involves multiple investigators from multiple viewpoints.”

The grant’s other coprincipal, Rama Rao Amara, professor of microbiology and immunology and a researcher at Yerkes, says the team will focus on the twofold goal of cultivating a vaccine that will prevent HIV and finding a long-term cure for people who are already infected.

"Generating a long-lasting, protective antibody response at the site of HIV entry is key to stopping its transmission and is one objective of our new NIH-funded research program to develop new strategies for preventing and curing HIV/AIDS," Amara explains.

Meanwhile, Emory researchers continue to make strides in understanding the science of HIV infection and how to help those who become infected remain healthy and limit the spread of the virus.

In October, scientists led by Aftab Ansari, professor of pathology and laboratory medicine at the School of Medicine and Yerkes, showed they can achieve sustained control of SIV infection in rhesus macaques, by supplementing antiretroviral drugs with an antibody during and after drug treatment.

Sustained control means that when antiretroviral drugs were stopped, the virus did not reemerge and cause disease. This was the first consistent demonstration of post-treatment immune control in monkeys infected with SIV without previous vaccination. The findings, published in Science, could provide a blueprint for long-lasting HIV treatment, and follow-up clinical research has begun.

United Nations building and flags

From Atlanta
to the UN

Driffin and Armstrong
Emory professor Wendy Armstrong and Atlanta activist Daniel Driffin, shown here outside the Ponce Center in Midtown Atlanta, serve as cochairs of the Fulton County Task Force on HIV/AIDS.

As Emory researchers strive to develop new treatments and vaccines for HIV, they continue to work to prevent new infections and improve access to care — both in our local community and around the world.

In Atlanta, the Fulton County Task Force on HIV/AIDS — cochaired by Wendy Armstrong, professor of infectious diseases at Emory’s School of Medicine — makes recommendations on improving access to treatment and prevention.

"Our mission was to develop a blueprint to combat AIDS in Fulton County,” Armstrong says.

School of Medicine and Rollins School of Public Health faculty played a significant role in a new phase of strategy rolled out in June, focusing on four overall goals: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, reducing HIV-related disparities and health inequities, and achieving a more coordinated response to the epidemic.

Meanwhile, a 30-year HIV prevention and research initiative in Rwanda, led by Emory, the Rwanda Ministry of Health, and the CDC has resulted in the prevention of more than 70 percent of new HIV infections in Rwanda, according to a study released in August 2016.

In Rwanda, more than 90 percent of new infections occur in cohabiting couples. The Couples’ Voluntary HIV Counseling and Testing program (CVCT) gives both partners the opportunity to share their HIV test results, jointly address issues of HIV transmission and family planning, and support each other if both are infected. CVCT is also associated with reducing mother-to-baby transmission.

Reflecting this global view, Emory’s Carlos del Rio, codirector of the Center for AIDS Research, was invited to speak at the Joint United Nations Programme on HIV/AIDS (UNAIDS) in June 2016. He addressed the leadership meeting of “90-90-90 and Human Resources for Health,” the ambitious plan developed by UNAIDS targeting that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression.

“Our biggest challenge as a society is clear," del Rio says. "We must strive for a world where there is no one living in extreme poverty, where access to education and health is a right, and where human rights are respected. If we do that, not only will we end AIDS, but many of the major scourges we suffer.”

And until that goal is achieved, Emory researchers and physicians will remain on the front lines, striving to improve the health of communities in our region and around the world.