编者按：7月26日，第25届国际艾滋病大会（AIDS2024）在德国慕尼黑圆满谢幕。本次盛会不仅汇聚了全球顶尖的艾滋病防治专家、领导人及社会各界力量，更激发了人们对消除艾滋病威胁的坚定信念与决心。《感染医线》非常荣幸地邀请到国际艾滋病协会（IAS）主席、AIDS2024联合主席Sharon Lewin教授进行了深度访谈。Lewin主席指出，尽管HIV仍然是全球公共卫生领域的重要威胁，但最新的科学研究为HIV/AIDS的防治带来了前所未有的希望。无论是通过长效注射药物预防HIV感染的新方法，还是关于HIV转录抑制以实现治愈的“沉默”策略，都展示了科学界在应对这一全球挑战上的不懈努力。同时，会议也强调了社区在推动防治工作中的核心作用，呼吁全球共同关注并致力于终结艾滋病的伟大事业。
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《感染医线》：Lewin教授，作为AIDS 2024大会的主席，您如何看待当前全球HIV/AIDS研究领域的最新进展和未来趋势？
Sharon Lewin主席：今天是2024年慕尼黑艾滋病大会的最后一天，这真是一场令人印象深刻的会议。它向我们传达了一些关键信息。首先，HIV仍然是一个严重的公共卫生威胁，我们尚未实现消除艾滋病威胁的目标。更重要的是，HIV在世界不同地区的流行病学情况呈现出显著的差异。我们看到，在撒哈拉以南非洲的许多国家，新感染HIV人数有所减少，取得了令人瞩目的防控成果，但在世界其他地区，HIV新感染人数却在增加。事实上，今年是非洲以外地区的新感染人数首次超过非洲的一年，这一情况令人担忧。我们最关注的地区包括东欧和中亚（这也是我们今年在慕尼黑举行会议的原因之一）、北非和中东以及拉丁美洲，这些地区的新发HIV感染人数正在不断上升，在某些地区，艾滋病相关死亡人数也在增加。
另一方面，本届大会也给我们带来了一些好消息，那就是有了新的预防HIV感染的方法。我们已经有口服的暴露前预防（PrEP）药物来预防HIV感染。然而，长期每天都服药是相当困难的，尤其是当他们完全健康、没有症状的时候。到目前为止，已有研究表明每两个月注射一次的PrEP也非常有效。更令人振奋的是，在本届大会上我们看到，在撒哈拉以南的非洲地区，采用lenacapavir每六个月进行一次注射的新方法，在女性中实现了零新感染病例。该项研究具有非常重要的临床意义，它将在很大程度上解决患者的依从性问题。
此外，还有另一个重磅消息与第七例艾滋病治愈病例有关。当前对于全球3900万HIV感染者来说，仍需要终身接受抗逆转录病毒治疗，这无疑给他们带来了巨大的负担。因此，寻找更有效的治疗方法仍然是全球艾滋病研究的重要方向。第七例艾滋病治愈病例无疑给我们照亮了前进的方向。
IIDF：As the chair of AIDS 2024, how do you view the latest advancements and future trends in the global HIV/AIDS research landscape?
Dr Lewin: Well, we are on the last day of AIDS 2024 in Munich, and it has been quite an incredible conference. I think it has told us a few key things. First of all, HIV is not over as a public health threat, and we are not on track to meet our targets. More importantly, the HIV story is different in different parts of the world. We are seeing some incredible successes with decreases in new infections in many countries across sub-Saharan Africa, but increases in new infections in other parts of the world. In fact, this year was the first year there were more infections outside of Africa than inside Africa. The regions of the world we are most concerned about are Eastern Europe and Central Asia (the reason why we are holding the meeting in Munich), North Africa and the Middle East, and Latin America, where we are seeing increasing numbers of HIV acquisitions, and in some cases, increasing numbers of AIDS-related deaths. On the flip-side, we have had some very good news at this conference with new ways to prevent HIV acquisitions. We’ve had pre-exposure prophylaxis tablets to prevent acquiring HIV available for some time. But taking a tablet every day is quite difficult for people, especially when they are completely well. It is a bit like taking the oral contraceptive every day, and sometimes, people are not so good at taking it. What we have learned is that injectable PrEP, an injection every two months, is also very effective. But what we learned at this meeting was that in a new approach of injectable treatment every six months with a drug called lenacapavir in sub-Saharan Africa amongst women, there were no new infections, which is quite extraordinary. I think a lot of that is related to compliance - turning up for an injection. The final big story at the meeting was related to the seventh case of a cure. We are reminded that a cure is still urgently needed for the 39 million people living with HIV, all of whom need lifelong antiretroviral treatment with the current approach of managing HIV.
AIDS 2024 Co-Chairs' Choice大会现场
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《感染医线》：您认为当前实现HIV功能性治愈或完全治愈面临的最大挑战是什么？大会的主题的设定有什么深层含义？
Sharon Lewin主席：实现艾滋病治愈的最大挑战在于，HIV可以整合进感染者的DNA中。换而言之，一旦感染HIV，病毒将伴随终身。尽管如此，我们现在已经了解到，消除这种病毒是可行的，例如通过干细胞移植可以达到这一目的。然而，干细胞移植并不适合作为艾滋病的常规治疗方法，因为它伴随着诸多副作用且费用高昂。我们所知的七例通过移植治愈艾滋病的案例，其实是因为这些患者同时患有需要移植治疗的恶性血液肿瘤——白血病。然而这些案例证明了消除HIV的可能性。我们目前拥有许多充满希望的新策略，其中之一是增强机体对HIV的免疫控制。这可以通过使用抗体实现，甚至可能利用治疗癌症的药物和免疫疗法来达到。此外，基因治疗领域也取得了显著进展。我认为，基因治疗可以从本届大会上报道的治愈病例中汲取许多宝贵的经验。
IIDF：What do you consider to be the biggest challenge facing the achievement of functional or complete cure for HIV?What is the deeper meaning behind the theme setting of the conference?
Dr Lewin: The biggest challenge in achieving a cure for HIV is the fact that the virus becomes part of our own DNA. Once a person is infected with HIV, the virus stays there for life. However, we now know that it is possible to get rid of that virus - for example, stem cell transplants can get rid of that virus - but stem cell transplants can’t be used for a cure for HIV because there are a lot of associated side effects and very expensive. Not suitable. The only reason why we know of the seven people cured of HIV following a transplant is because they had to have a transplant because of their blood disorder, leukemia. But we know it is possible to get rid of the virus. We have many new strategies that are looking promising. One of those is boosting the immune control of HIV, and we know that is possible through antibodies, and even using drugs that treat cancer, immunotherapy. Ands we have seen big advances in gene therapy. I think gene therapy can learn a lot from the cured cases we heard reported here.
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《感染医线》：在大会中，哪些研究成果或议题最让您感到兴奋或期待？为什么它们对HIV/AIDS领域具有重要意义？
Sharon Lewin主席：我最感兴趣的科学报告聚焦于一种创新的预防策略——利用长效注射药物来预防HIV的新途径。然而，将这一策略成功应用于实践的核心挑战在于药物的成本问题。鉴于预防HIV的药物价格高昂，而这些药物在最贫困国家的需求又最为迫切，因此，确保这些药物能够广泛惠及患者显得尤为关键。此外，会议中还呈现了另一项振奋人心的报告，即探讨通过抑制HIV转录以实现治愈的新方法，这一策略被称为“沉默”。今日早晨，我们有幸聆听了Melanie Ott教授的精彩报告。同时，关于人工智能在HIV护理中潜在应用的讨论也引起了广泛关注，这些新兴科技无疑将对医疗资源的优化配置产生深远影响。同时，关于人工智能在HIV护理中潜在应用的讨论也引起了广泛关注，这些新兴科技无疑将对医疗资源的优化配置产生深远影响。
IIDF：What research findings or topics at the conference are you most excited or looking forward to, and why do they hold significant importance for the HIV/AIDS field?
Dr Lewin: The scientific presentations I am most excited about are around new prevention strategies - new ways to prevent HIV from long-acting antiviral treatment. What I am most concerned about is whether we are going to be able to get those strategies to the places we need to get them to, and that is related to the drug cost. There was a lot of discussion at this meeting about how the prevention drugs will be priced, because governments will not want to pay high amounts for a drug to prevent HIV, and certainly these drugs are needed most in the poorest countries. We need to make very certain that the manufacturers of the drugs can not only survive financially, but that these drugs are accessible. The other exciting presentations at this meeting were on new ways to approach a cure by putting the virus permanently to sleep, what we call silencing. We heard a fantastic overview of that this morning from Melanie Ott. And there is some really interesting stuff around AI, and how artificial intelligence may do a better job in some components of HIV care, and if used responsibly, could have a big impact on healthcare resourcing.
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《感染医线》：未来，您认为HIV/AIDS防治工作应该如何适应和调整，以确保持续进展和成效？
Sharon Lewin主席：我们必须确保人们不会忽视艾滋病问题，因为艾滋病依然是一场肆虐全球的严重流行病，仅在去年就导致了63万人的不幸离世。投资于艾滋病新技术、加强医疗保健系统建设、支持社区发展以及临床试验网络的建设，这些举措都具有深远的意义，它们不仅直接应对了艾滋病的挑战，还显著增强了我们对未来流行病的抵御能力。同时，我们必须警惕HIV感染者中结核病和乙型肝炎等其他传染病的高发病率，这意味着我们的努力将在多个健康领域产生广泛而深远的影响。
本次会议所传递的核心信息在于：首先，我们必须坚持以人为本的原则，让社区成为推动防治工作的引领者。这是公共卫生领域不可或缺的重要基石。尽管HIV/AIDS的防治工作已经取得了显著的进展，但我们仍需保持警惕，坚持不懈地努力，因为前方的道路依旧漫长且充满未知的挑战。我们必须保持对艾滋病问题的持续关注，并不断创新和完善我们的应对策略，以确保更多的人能够免受艾滋病的侵害。
IIDF：Looking into the future, how do you believe HIV/AIDS prevention and treatment efforts should adapt and adjust to ensure continuous progress and effectiveness?
Dr Lewin: We have to make sure that people don’t think HIV is over. HIV is still a major global pandemic - 630000 deaths from HIV just last year. Investments in new technologies for HIV, investments in strengthening healthcare systems, investments in communities, investments in clinical trial networks is of great value, not just for the HIV response, but in our resilience and ability to be prepared for future pandemics. At the same time, many other infectious disease occur at higher rates in people living with HIV, for example, tuberculosis and hepatitis B. Therefore, we are going to have a big impact on many other areas outside. So I think the most important message from the conference is, first, put people first and let communities lead. This is a critical principle of excellent public health. The HIV investment is paying off, but we still have a long way to go.
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《感染医线》：作为大会主席，您希望通过AIDS 2024向全球传递怎样的信息或愿景？对于年轻研究人员，您有哪些寄语或建议？
Sharon Lewin主席：本次大会传达的主要信息是希望。我们在这里见证了一些具有变革意义的科学研究，例如长效注射药物lenacapavir展现出的卓越的预防HIV感染的能力。此外，我们也见证了更多的治疗方法涌现，例如“下一个柏林患者”案例。然而，即使在40年后的今天，关于HIV仍有许多尚未发现和未知的信息。我们拥有如此多的新技术可以应用，无论是在实验室中逐个分析单个细胞的能力，还是在医疗保健诊所或政府中使用大数据来做出更好、更明智的决策。多年来，我们从艾滋病运动中学习到的是，当我们将科学、社区和热情结合在一起时，就可以成就伟大的事业。这就是我们在慕尼黑AIDS2024大会上所看到的，也是我们希望在艾滋病防治工作中希望看到的景象。
这是传染病研究的黄金时代。我们已亲眼目睹COVID-19疫情对全球造成的深远影响。因此，我们亟需更多青年才俊投身于流行病学的研究中。当前，艾滋病仍然是威胁全球的重大传染性疾病，在终结这一公共卫生危机方面，我们仍面临艰巨的任务和繁重的工作。如果我现在是一位年轻的科学家，我将会对我们在艾滋病应对工作中所能够做出及即将开展的贡献感到无比的兴奋与期待。
IIDF：As the chair of AIDS 2024, what message or vision do you hope to convey to the world through this conference? And for young researchers, what advice or encouragement would you like to offer?
Dr Lewin: The main message from the Conference is one of hope, I think. We have seen some transformational science here. The ability to prevent any new infections with lenacapavir is truly extraordinary. The fact we are seeing more cures, for example, the “next Berlin patient”. There is so much that is still not discovered and not known about the virus, even after 40 years. We have so much new technology that we can apply, whether it is in a laboratory and the ability to analyze single cells one-by-one, or whether it is in the healthcare clinic or government using big data to make better and informed decisions. But I think what we know from the AIDS movement is that when you bring science, community and activism together, you can achieve great things. I think that is what we have seen here in Munich at this meeting, and what we hope to continue to see in the HIV response.
I think this is the golden era of infectious diseases. We saw what a virus like COVID could do for the world. We need more people to commit to solving pandemics such as COVID-19, but HIV remains a really significant disruptor of countries, communities and families, and there is still so much to do to see the end of HIV. If I was a young scientist now, I would be really excited about we can do and what we are going to do in the response to HIV.