A Q&A with the director of the Penn Center for AIDS Research

Can you talk a bit about the overall state of AIDS research and care in the U.S. today, whether that's gene therapy approaches, PrEP access, or progress toward transmission goals?

We do have great drugs, but in the U.S., we have about 1.2 million people living with HIV and we still have about 32,000 new infections a year. Of the people living with HIV, only two-thirds of them are virologically suppressed with drugs, mostly because of social and structural issues that impede people's ability to engage and remain in care. Some people still don't know their status, and many people have challenges of mental health, substance use, poverty, housing instability, and similar issues.

And even for the two-thirds of people who are virologically suppressed, it's not like not having HIV. They have increased rates of what we consider diseases of aging: cardiovascular disease, neurocognitive decline, bone disease, frailty, kidney failure, liver failure. It's getting better, but they still have a shorter lifespan, which we need to better understand. For prevention, oral PrEP works great except for the fact that it is only getting to a small fraction of the people who are at risk, and people often don't take it consistently.

Two big areas of focus in the field are on trying to develop a vaccine to prevent infection and to develop a cure for those living with the virus. This research is really important to move the HIV/AIDS mission forward, but it has had incredible collateral impact also. I'll give you two examples at Penn. Carl Junecame to Penn 25 years ago as an AIDS researcher. He developed his program of expanding T cells in vitro and then reinfusing them into patients to try to achieve an HIV cure. He developed the approaches that he then applied to cancer. Drew Weissmancame to Penn as an AIDS investigator and his first papers reporting modified RNA vaccines were all about an HIV vaccine.

Basic science AIDS research remans a great strength here, and some of the most exciting progress in the HIV vaccine field is being done by Penn CFAR investigators, as well as work that we hope will ultimately lead to a cure. Some people may perceive AIDS research to be sort of a niche, but it's not. It gave rise to cell-based therapy, it gave rise to mRNA vaccines, it has led to a huge explosion of what we know in immunology, and it has had substantial impact at Penn and worldwide.

What is the state of HIV transmission in Philadelphia, and what is Penn CFAR is doing to help address gaps in care?

In the Philadelphia region, we have about 30,000 people living with HIV, 20,000 in the city itself. Within the city alone, there are about 400 new identified infections per year, and so much of what the CFAR is doing is working on implementation science and PrEP.

We have formed a really tight partnershipwith the Philadelphia Department of Public Health. We've tried to use the CFAR as a vehicle to leverage all this great academic expertise of the University of Pennsylvania to do research that can fill the knowledge gaps that the Department of Public Health needs to improve its implementation programs. Kathleen Brady, the director of HIV health at the Department of Public Health, is a co-leader of the CFAR and helps make sure that our work aligns with PDPH needs and that PDPH and CFAR work in partnership.

For example, the Department of Public Health spends about $10 million a year on medical case management for people living with HIV, and medical case management is to try and make sure that people stay in care. But how do you know whether you're keeping people in care who otherwise would not be in care or are providing services for people who would still be in care anyway? It turns out that the dean of the School of Social Policy & Practice, Sara Bachman, is an expert in studying medical case management systems. She is leading a project to study the Department of Public Health medical case management system and figure out if it is accomplishing what wouldn't happen otherwise.

Another example is the Department of Public Health is about to launch a program for extended transitional housing for people with housing instability living with HIV. When somebody doesn't have a place to live, taking their HIV meds may not be very high on their priority list. We have funded three projects that will be built into the program to figure out: Is this doing what the goal is to improve HIV care?

You mentioned the School of Social Policy & Practice. What other schools are doing work with the CFAR?

Antonia Villarruel, the dean of the School of Nursing, was at Penn as a brand-new young investigator and one of her first grants was a pilot grant from the CFAR. That helped her gain traction in studying HIV in the Latino community. She went to the University of Michigan but came back as dean. Nursing is one of our biggest collaborators. José Bauermeister, who also runs the Eidos LGBTQ+ Health Initiative, is an important HIV investigator, and Nursing has multiple super investigators.

We have a new program that is based in part in the Annenberg School for Communication. [Penn Integrates Knowledge] Professor Dolores Albarracínalong with her colleague Bita Fayaz-Farkhadand John Holmesfrom the Department of Biostatistics, Epidemiology and Informaticsare leading a new initiative we're putting funds toward called the HIV Communication & Policy Scientific Working Group. It's to try to understand how communication and policies around HIV affect HIV incidence, prevalence, and engagement in care.

We have had a program in the School of Dental Medicinefor a long time. Our program in the Dental School has interestingly been neurocognitive AIDS, led by Kelly L. Jordan-Sciutto, though now we have a program on HIV and oral health. We have had collaborations with the School of Veterinary Medicine, and they have a recently recruited faculty member, Michael J. Hogan, working on HIV-related issues. There are multiple investigators in the School of Engineering and Applied Science addressing areas of importance for HIV/AIDS, particularly novel diagnostic devices.

One of the highest-risk time periods for falling out of care and discontinuing ART is when people leave prison or jail, and so we have this group that will try to understand and improve post-incarceration HIV care. It includes investigators from Social Policy & Practice, the Department of Sociologyin the School of Arts & Sciences,and the Perelman School of Medicine.

The Center was just funded by the National Institutes of Health at $14.7 million for 2024-29. Can you talk about the NIH partnership and what that allows you to do?

The bulk of our money goes to cores that provide research services and to funding pilot projects. We focus either on young investigators to help them get traction in AIDS research and launch their careers or established investigators who don't work in AIDS fields but whose scientific domain could and should be applied to AIDS-related questions. One of the most exciting things for me is that we have an incredibly talented group of emerging investigators across the spectrum of AIDS research topics, from basic science to prevention to implementation science, that the CFAR has helped establish and will be the next generation that hopefully puts this field out of business.

The Perelman School of Medicine has been very supportive-J. Larry Jameson, when he was dean, and now Jon Epstein. They provide substantial additional funding beyond what the NIH is able to provide to us, and it's incredibly important. They provide a lot of our educational activities. They have augmented the funds for our scientific working groups and augmented our funding for our diversity pipeline initiative, so we're really fortunate and appreciative of the School of Medicine support.