Publications by authors named "Mitchell Warren"

Article Synopsis
  • Large studies have demonstrated that new long-acting HIV medications are effective and well-received, but their distribution needs better organization, especially in low-income countries with high HIV rates.
  • Coordinated efforts from stakeholders like WHO, financial donors, and governments are urgently needed to ensure these treatments reach everyone who could benefit, as currently only a small percentage of eligible individuals do.
  • Without immediate action to coordinate the rollout of these medications, access to them could be significantly delayed, hindering progress towards global HIV eradication goals set for the 2030s.
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Current serologic tests for HIV screening and confirmation of infection present challenges to the adoption of HIV vaccines. The detection of vaccine-induced HIV-1 antibodies in the absence of HIV-1 infection, referred to as vaccine-induced seropositivity/seroreactivity, confounds the interpretation of test results, causing misclassification of HIV-1 status with potential affiliated stigmatization. For HIV vaccines to be widely adopted with high community confidence and uptake, tests are needed that are agnostic to the vaccination status of tested individuals (ie, positive only for true HIV-1 infection).

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Introduction: Data from two randomized controlled trials (RCTs) showed that injectable cabotegravir (CAB) for pre-exposure prophylaxis (PrEP) was efficacious in reducing HIV acquisition. The US Food and Drug Administration approved CAB for PrEP in December 2021; Australia in August 2022; Zimbabwe in October 2022; South Africa in November 2022; Malawi in March 2023; and regulatory approvals are being sought in additional countries. The World Health Organization (WHO) recommended CAB be offered to people at substantial risk of HIV in July 2022.

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Article Synopsis
  • The study evaluates the potential health benefits and risks of introducing long-acting injectable cabotegravir pre-exposure prophylaxis (PrEP) for HIV prevention in sub-Saharan Africa, considering concerns about the emergence of integrase-inhibitor resistance in treatment programs.
  • The researchers used a comprehensive HIV model to simulate various scenarios over 50 years, comparing outcomes with and without the introduction of cabotegravir-PrEP, targeting individuals at risk of developing drug resistance.
  • Cost-effectiveness analysis suggests that cabotegravir-PrEP could be comparable in price to current oral PrEP options, with the potential to significantly reduce HIV transmission while carefully monitoring the risk of resistance.
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Article Synopsis
  • The HIV Research for Prevention (HIVR4P) conference focuses on sharing knowledge about various HIV prevention methods, including vaccines, antibody treatments, pre-exposure prophylaxis, and microbicides, from scientific details to social factors.
  • The virtual conference took place over two weekends in January and February 2021, attracting 1,802 participants from 92 countries amidst the COVID-19 pandemic.
  • The event featured 113 oral presentations and 266 poster presentations, summarizing key research and findings in HIV prevention, with additional resources available on the conference website.
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With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers.

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Developing a cure for HIV is a global priority. Target product profiles are a tool commonly used throughout the drug development process to align interested parties around a clear set of goals or requirements for a potential product. Three distinct therapeutic modalities (combination therapies, ex-vivo gene therapy, and in-vivo gene therapy) for a target product profile for an HIV cure were identified.

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In light of the increasing global burden of new HIV infections, growing financial requirements, and shifting funding landscape, the global health community must accelerate the development and delivery of an HIV cure to complement existing prevention modalities. An effective curative intervention could prevent new infections, overcome the limitations of antiretroviral treatment, combat stigma and discrimination, and provide a sustainable financial solution for pandemic control. We propose steps to plan for an HIV cure now, including defining a target product profile and establishing the HIV Cure Africa Acceleration Partnership (HCAAP), a multidisciplinary public-private partnership that will catalyse and promote HIV cure research through diverse stakeholder engagement.

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The HIV Research for Prevention (HIVR4P) conference is dedicated to advancing HIV prevention research, responding to a growing consensus that effective and durable prevention will require a combination of approaches as well as unprecedented collaboration among scientists, practitioners, and community workers from different fields and geographic areas. The conference theme in 2018, "From Research to Impact," acknowledged an increasing focus on translation of promising research findings into practical, accessible, and affordable HIV prevention options for those who need them worldwide. HIVR4P 2018 was held in Madrid, Spain, on 21-25 October, with >1,400 participants from 52 countries around the globe, representing all aspects of HIV prevention research and implementation.

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In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably.

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This case describes an obese adult male peritoneal dialysis patient who presented with a pruritic follicular rash. Nutrient deficiency was not suspected initially in this case because there was no history of protein-calorie malnutrition, but the patient reported a diet devoid of fruits and vegetables and had not been taking his dialysis vitamin as prescribed. Skin biopsy showed follicular hyperkeratosis with fragmented hair shafts and corkscrew hairs consistent with scurvy.

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Introduction: The science presented at the 21st International AIDS Conference in Durban, South Africa, in July 2016, addressed the state of the field across basic, clinical, prevention, law and policy and implementation science.

Methods And Results: The AIDS response has seen remarkable achievements in scientific advances, in translation of those advances into prevention, treatment and care for affected individuals and communities, and in large scale implementation - reaching 18 million people with antiviral therapy by mid-year 2016. Yet incident HIV infections in adults remain stubbornly stable and are increasing in some regions and among adolescents and adults in some key populations, challenging current science, policy and programming.

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Article Synopsis
  • - HIVR4P (HIV Research for Prevention) emphasizes the need for a combination of approaches to effectively combat the global HIV/AIDS epidemic, focusing on various biomedical strategies including vaccines and microbicides.
  • - The 2016 conference, held in Chicago, featured over 700 scientific presentations and aimed to foster collaboration among diverse stakeholders in the HIV prevention field with the theme "Partnering for Prevention."
  • - With participants from 42 countries, the conference highlighted a commitment to supporting early career researchers, ensuring sustainable progress in HIV prevention research for the future.
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Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services.

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Marine fish abundance and distribution often varies across spatial scales for a variety of reasons, and this variability has significant ecological and management consequences. We quantified the distribution of reef-associated fish species along the southeast United States Atlantic coast using underwater video survey samples (N = 4,855 in 2011-2014) to elucidate variability within species across space, depths, and habitats, as well as describe broad-scale patterns in species richness. Thirty-two species were seen at least 10 times on video, and the most commonly observed species were red porgy (Pagrus pagrus; 41.

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Although effective programmes are available and several countries have seen substantial declines in new HIV infections, progress in the reduction of adult HIV incidence has been slower than expected worldwide and many countries have not had large decreases in new infections in adults despite large reductions in paediatric infections. Reasons for slow progress include inadequate commitment, investment, focus, scale, and quality of implementation of prevention and treatment interventions. The UNAIDS-Lancet Commission on Defeating AIDS-Advancing Global Health reported that the provision of large-scale, effective HIV prevention programmes has failed and called on stakeholders to "get serious about HIV prevention".

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Background: The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE.

Methods: An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070.

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Introduction: After the initial approval of the use of tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti-HIV pre-exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations.

Discussion: Demonstration projects are underway to determine the best practices in the United States to identify at-risk individuals in primary care and sexually transmitted disease clinics who could benefit from PrEP. Studies of PrEP in combination with behavioural interventions are being evaluated.

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Introduction: The extraordinary feat of proving the effectiveness of oral pre-exposure prophylaxis (PrEP) in clinical trials in different populations in a variety of settings may prove to have been easier than ensuring it is used well. Decision-makers must make difficult choices to realize the promise of antiretroviral prophylaxis for their countries. This paper outlines key economic, regulatory and distributive justice issues that must be addressed for effective and acceptable PrEP implementation.

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