Advertisement
I have spoken to Professor Sharon Lewin many times in the past two years. Yet until I sat down to lunch with her, we had never properly met. As a health reporter at The Age, my interactions with her were limited to politically charged press conferences or interviews over the phone ahead of a deadline, with the director of the Peter Doherty Institute for Infection and Immunity typically answering questions in a clear, gentle and calm manner. Some might say that The Age and Sydney Morning Herald owe her (and countless other scientists and frontline healthcare workers) a free lunch for the hours they have spent being interviewed during the pandemic. Credit:Luis Enrique Ascui
Lewin walks into Bistro Gitan, a bustling contemporary French and Spanish-inspired restaurant in South Yarra, and gives me a big hug, as if she were greeting an old friend. The bistro is a favourite haunt of Lewin’s. She suggests we share an entree of Kingfish tartare with nori rice crisps, Yarra Valley salmon caviar and finger lime dressing. She orders the salade de chevre chaud with fig, walnut and port wine dressing for her main course, while I opt for the pumpkin Parisian gnocchi. Has she had coronavirus? Not yet, but her youngest Max was recently ill with it. What is she looking forward to most this year? “My 60th birthday in Greece,” she says. An entree of Kingfish tartare with nori rice crisp, Yarra Valley salmon caviar and finger lime dressing at Bistro Gitan. Credit:Luis Enrique Ascui
Our conversation quickly turns to the media storm surrounding the pandemic. When the phone calls from journalists started coming in about a mysterious virus leaving people breathless and feverish in the Chinese city of Wuhan in 2020, Lewin felt a familiar pang of adrenaline. Memories flooded back of co-chairing the world’s largest AIDS conference in Melbourne in 2014, which brought together global pioneers united in the quest to cure the deadly disease. The event had been years in the making, but Lewin was left reeling after Malaysian Airlines flight MH17, carrying six leading figures in HIV research and activism, was shot down over eastern Ukraine, an atrocity that claimed the lives of 298 people. Advertisement
“It was a devastating way for anyone to die,” Lewin says.“They were my friends and colleagues. Two of them I knew very well. It was this experience of really high anxiety and great uncertainty. You’re trying to gather all the information to understand what’s happened and there was this intense media interest locally and internationally.”
“A devastating way for anyone to die”: Debris from Malaysian Airlines flight MH17 in eastern Ukraine in 2014. 
Credit:Kate Geraghty
Among the dead was former International AIDS Society president Professor Joep Lange, a friend of Lewin’s , who saved countless lives by increasing access to anti-retroviral therapy for millions of people infected with HIV in poverty-stricken countries. The calls from reporters after MH17’s destruction only lasted 48 hours, but it was a crash course of sorts that would serve Lewin well when a consortium of modellers, led by the Doherty Institute, became the architects of a report underpinning the Morrison government’s reopening of Australia after two years of COVID isolation. The stakes were immense. Protesters were on the streets agitating for freedoms every week. Lewin remembers the anxiety around the release of the document being palpable. As the spokeswoman for the institute, she did her best to shield her staff from the scrutiny. “Questions were being raised about where Doherty was positioned,” Lewin says. “It was an incredibly stressful time. We’re a scientific organisation. We are not public policy or the government. We would never compromise what we do. We provide information on data and science to governments to make decisions. That line was getting very blurred last September.”
How did she cope? At the beginning, it was just the bare bones of survival, she tells me. Days stretched from 6am until late in the evening. Lewin slept for a few hours before waking to overseas phone calls at 3 or 4am. Mornings were filled with Doherty Institute briefings to discuss the latest science. Then it was on to media requests and an endless blur of Zoom meetings. The salade de chevre chaud (warm goat’s cheese salad) with fig, walnut and port wine dressing at Bistro Gitan. Credit:Luis Enrique Ascui
Somehow, she managed to continue her work as chief investigator of the National Health and Medical Research Council of Australia, as well as overseeing a group of young HIV researchers and being a leading member of the International AIDS Society. Lewin believes she inherited her mum Eva’s work ethic and optimism. A Polish-born refugee, Eva retired from working as an accountant’s assistant only three years ago, at the age of 83. She was the first person at the accounting firm each day, except Fridays, when she was cooking a feast at home for her family. Lively Friday night family dinners have been a lifelong tradition for Lewin, who is Jewish. But during lockdowns the ritual morphed into a rare moment of solace with her husband Robert and their two sons, Max, 25, and Alex, 28, who were both still living at home. “I loved being with the boys,” she says. “There was a such a calmness to the weekends I don’t normally have in an ordinary year because I wasn’t travelling all the time for work.”
After Friday night dinner, they watched an episode of Succession or The Crown on Netflix. But there was no bingeing. It was a once-a-week treat. Lewin, who is not a fan of Uber Eats, unwinds by cooking every night. One of her favourite cuisines is Malaysian. She has a well-worn rotating cycle of curry laksa and beef rendang dishes that she has spent years perfecting. She runs to quieten her mind. During all six lockdowns, she regularly ran five kilometres along a familiar route of deserted streets near her home. Those 30 minutes were spent listening to a podcast, either This American Life or catching up on the latest coronavirus data with The New England Journal of Medicine. Pre-pandemic, Lewin spent much of the year travelling the world, working to find a cure for HIV. Sharon Lewin, then a researcher with the Burnet Institute trying to find a cure for HIV, in the week leading up to the 20th International AIDS Conference in Melbourne. Credit:Craig Sillitoe
She has been pivotal in advancing understanding of HIV latency: how the virus buries itself in DNA and lingers forever in people despite anti-retroviral treatment. HIV has been the biggest pandemic the world has ever seen, Lewin says, creating a generation of virologists, immunologists and scientists who have dedicated their lives to understanding the complex interplay of viruses and the immune system. Most are now at the forefront of the fight against COVID-19, including Lewin and her friend Dr Anthony Fauci , a senior adviser to the White House’s COVID Response. Fauci and Lewin were speaking together in an online COVID-19 panel discussion the day that restrictions on restaurants were lifted in Melbourne in October 2020 after nearly four months. Hours later she would dine out with her family for the first time in months at Chin Chin in Melbourne’s city centre. A naturally curious child, Lewin excelled at maths, physics and chemistry. She dreamt of being an astronaut or an engineer but was strongly encouraged by her parents to study medicine at Monash University. “I grew to really love it,” she says. “I loved the human connection. Being a doctor is a really great privilege because you are often looking after somebody at a very challenging time in their lives.”
But her mind always drifted back to research: “I began to want to have an impact beyond the person sitting in front of me.”
Loading
I meet Lewin for lunch as hospitalisations are soaring in a new wave of flu and coronavirus infections. What will become of COVID-19? “We are in for a very tough winter,” she says. Tens of thousands of new cases and dozens of deaths are still being reported every day in Australia. Once a global leader in preventing COVID-19 deaths, Lewin warns Australia is falling behind in its ability to monitor the virus. Lewin wants a national registry to track people with “long COVID” to understand the mechanisms of the perplexing, post-viral syndrome. She fears not enough is being done to generate awareness about life-saving antiviral drugs to limit the impact of COVID-19, which often need to be taken within five days of symptoms. “We need to start getting the word out about antiviral treatments and ensure everyone who needs them has access,” she says. Lunch at a local favourite. The emergence of another COVID-19 variant is almost certain and a strain able to evade current vaccines can never be ruled out. “That would change the bar significantly,” Lewin says, noting that even Omicron continued to put immense pressure on hospitals, schools and workplaces across the country. While she believes the days of lockdowns and stay-at-home orders are largely behind us, she says Australians should be using masks indoors, staying at home when sick and “doing everything they can” to try stop spreading COVID and the flu. Another global outbreak of infectious disease is inevitable. Scientists warn climate change, increased interactions with wildlife, megacities and globalisation are accelerating this threat. COVID-19 is probably not a once-in-a-century event; it may not even be a once-in-a-generation one. Lewin says our top priority should be ensuring Australia enacts national policies in dealing with future outbreaks of deadly infectious diseases, to ensure a unified response across states and territories. “We need to put things in place now so the next [one] will not spread as fast and as far and wide as [COVID-19] has, and we definitely need to be prepared for the worst.”
As we finish our lunch, I ask Lewin what has been the silver lining of the pandemic for her. Her eyes light up as she tells me it is that scientific literature has become part of our ordinary vocabulary. “It doesn’t matter who you are, whether you’re a taxi driver or a cleaner, everyone knows the letters mRNA, everyone knows what a rapid antigen test is,” Lewin says. “The level of scientific literacy is just extraordinary.”
THE BILL, PLEASE
Bistro Gitan, 52 Toorak Road West, South Yarra VIC 3141, (03) 9867 5853. Open Tuesday-Friday 12-11pm, Saturday 6-11pm. Save

‘We are in for a tough winter’: Sharon Lewin, the clear-eyed optimist

Aug 3, 2021 11:50 AM ET
Tweet This: 
Blog
Over the past 18 months, the COVID-19 pandemic has brought the treatment and prevention of infectious diseases to center stage. For Dr. Adeeba Kamarulzaman, Dean of the Faculty of Medicine at University of Malaya in Kuala Lumpur, Malaysia, and Dr. Sharon Lewin, Professor of Medicine at the University of Melbourne in Melbourne, Australia, the pandemic offers an opportunity for the global health community to review its approach to HIV prevention and treatment and to plot a stronger course going forward. Adeeba is president of the International AIDS Society, the world's largest association of HIV/AIDS professionals, and Sharon is president-elect and will assume the post next summer. On the heels of  the recent biennial IAS Conference on HIV Science, we spoke with the two experts about the intersection of COVID-19 and HIV and the ways to help bring an end to the epidemic. How has the pandemic impacted HIV care, and what have we learned? Sharon: Without a doubt, gains have been lost with HIV, just as in every area of health sciences. Access to treatments, access to prevention strategies and testing rates - all of that was disrupted. But we will see investments in the diagnosis, treatment and prevention of all infectious diseases following COVID. After COVID, every country will have the capacity to do PCR (polymerase chain reaction) testing and every country will have the equipment for point of care PCR, which will greatly enhance access to HIV viral load tests. Once the pressure of COVID lessens, which it will, all of that infrastructure will be available for more timely diagnosis and monitoring of HIV, as well as other diseases, such as tuberculosis. Adeeba: All the lessons that we learned during the pandemic can be utilized in our ongoing efforts in HIV. COVID-19 has shown the importance of community organizations and how they can help ensure there’s no disruption in prevention and treatment services. In addition, there are innovations that were brought to the forefront and that we should further study, such as telemedicine support and the ability to conduct self-testing. Both could be avenues for people with HIV who are reluctant to seek care. What are the biggest global challenges in preventing and treating HIV? Adeeba: Stigma and discrimination remain the Achilles heel of efforts to end the HIV epidemic. Within many conservative countries around the world, whether it’s people who use drugs, men who have sex with men, sex workers or transgender people, the challenges they face very much have to do with stigma and discrimination. Existing policies and laws that criminalize a lot of these behaviors further hamper treatment and prevention efforts. Sharon: Helping end HIV depends on eliminating stigma as well as ensuring access to diagnostics and therapeutics. In 1989, at the beginning of the HIV epidemic, I worked in a small hospital in Kenya. We had no treatments to give to people and no one wanted to get tested because of the enormous stigma. Today, with 37 million people living with HIV around the world, stigma remains a significant barrier. Where would you invest greater global resources in HIV research? Adeeba: I hope to continue to shine a spotlight on the Asia Pacific region, as it isn’t where it needs to be in terms of the rate of decline in mortality or the rate of declining number of new infections. Strides in the region have not been as impressive as they have been in sub-Saharan Africa or other parts of the world. Part of the reason for that is the heterogeneity of the epidemic in Asia Pacific. So, a lot more work needs to be done. Sharon: There's still room to commit to make more treatments for HIV, such as further researching implants and long-acting oral agents, and the key will be making these available for everyone. We should also focus on a cure strategy. As hard as that is, it could be transformational. What do you think needs to be done to meet the United Nations’ 2030 goal of ending the AIDS epidemic? Adeeba: We are three times behind the promised targets in terms of the number of new infections and we still have millions of people dying, therefore we need to utilize science to create programs that are evidence-based and effective. We could model them off the fantastic examples of community-led programs utilized during COVID. Not only were they effective, but many were also cost effective. Sharon: I think the UN 2030 goals can be achieved because in countries like Australia and parts of the U.S. we've done it. There have been great gains in the world, but we're not near those targets at the moment. Maintaining those targets indefinitely is going to be the real challenge, which is why we need to pursue innovation as we work towards a vaccine and a cure.

International AIDS Society Leaders on the Future of HIV Prevention and Treatment

닫기
ViiV Healthcare, the HIV specialist owned by GlaxoSmithKline plc. (GSK), presented Dovato’s 48-week data of the phase 3 SALSA and 144-week data of TANGO at the 2021 International AIDS Society. The 2021 International AIDS Society was held online from July 18-21. Dovato, HIV treatment, is a two-drug regimen (2DR). SALSA is a phase 3 trial randomized, multi-center, open-label, and non-inferiority study. On the 493 HIV-1 infected adults that used the Current Regimen Therapy (CRT), transition to two-drug regimen Davato (50mg of dolutegravir and 300mg of lamivudine) was made. ViiV Healthcare presented 2DR Dovato’s 48-week data of the phase 3 SALSA and 144-week data of TANGO at the 2021 International AIDS Society. Also, its safety, effects, and drug tolerance were analyzed. The CRT is an anti-retroviral therapy of three or more drug regimen, including at least two of Nucleoside Reverse Transcriptase Inhibitors (NRTI), which virologically suppresses patients. More than 120 research organizations from North America, Europe, Asia-Pacific, South America, and Africa participated in the SALSA study. The treatment of 246 participants was switched to using Dovato while the rest 247 maintained CRT. According to the 48-week data of the SALSA study, the group that had made the transition to Dovato showed treatment effects sustained and the safety profile also consistent. On the 48th week of the research, 99.6 percent of the Dovato transition group sustained below 50c/mL of HIV-1 RNA. Thus, similar to 98.8 percent of the 3-drug regimen CRT group, Dovato’s effectiveness was proven. In the two groups, no patients with Confirmed Virologic Withdrawal or resistant variants were found. The percentages of overall Adverse Event (AE) were similar among the two groups. There were low chances of AE that led to the suspension of the research. Also, there were no serious deviant cases concerning the drugs in both of the groups. Both biomarkers of renal and bone changes showed a statistically significant and advantageous number in the Dovato group. The SALSA study includes a variety of HIV-infected participants treated with various regimens using more than three drugs. More than 120 research sites in North America, Europe, Asia-Pacific, South America, and Africa participated. Thirty-nine percent of them were older than fifty, and it was of diverse ethnic groups. “It is exciting to have more data re-affirming Dovato’s efficacy and positive barrier against resistance development,” said Professor Josep Llibre, the principal investigator of the SALSA study. “These findings show that can maintain virologically suppressed status with a two-drug regimen, lesser use of drugs.”
Also, ViiV Healthcare presented 144 weeks of phase 3 TANGO study, testing the efficacy of transition to Dovato from a three-drug regimen that contains tenofovir alafenamide (TAF)
After around three years of treatment, Dovato proved its non-inferiority to the TAF-based three-drug regimen in virological suppression. In the Dovato group, there were no cases of virological failure or resistance found. The overall adverse event rates of both groups were similar. In lipid changes, the Dovato group showed superiority. “SALSA is the second switch study to demonstrate Dovato’s non-inferior efficacy and high barrier to resistance, with no participants experiencing virologic failure in the Dovato arm of the study,” said Kimberly Smith, the head of research & development at Viiv Healthcare. “These findings demonstrate its versatility for participants who had previously been on a broad range of different regimens, cementing its place in the HIV treatment paradigm.”

GSK-affiliated HIV specialist ViiV proves non-inferiority of 2DR Dovato

August 2, 2021
Six monthly oral doses of islatravir (Merck), an investigational nucleoside reverse transcriptase translocation inhibitor, were generally well tolerated versus placebo for pre-exposure prophylaxis (PrEP) of HIV-1 infection in adults at low-risk of contracting HIV-1, according to the results of an ongoing phase 2a clinical trial presented at the virtual 11th International AIDS Society Conference on HIV Science. The investigators noted that the levels of islatravir in peripheral blood mononuclear cells (PBMCs) remained above the efficacy pharmacokinetics (PK) threshold for PrEP for both doses studied (60 mg and 120 mg) for 8 weeks following the last study dose. Islatravir is currently being evaluated in clinical trials for the treatment of HIV-1 infection in combination with other antiretrovirals, as well as for use as PrEP of HIV-1 infection as a single agent. The ongoing phase 2a trial—a randomized, double-blind, parallel assignment, placebo-controlled, multicenter study of adults at low-risk for acquiring HIV-1 infection—assigned participants to 1 of 3 groups in a 2:2:1 ratio. These groups each received once-monthly oral therapy over a 24-week blinded therapy period, either of islatravir 60 mg, islatravir 120 mg, or placebo. This was followed by a 12-week blinded follow-up for all groups and a 32-week unblinded follow-up for the islatravir groups to identify the terminal elimination phase. At the time of analysis, unblinded safety data showed that both doses of islatravir were generally well tolerated versus placebo over 24 weeks and most adverse events (AEs) were mild, according to the investigators. No serious drug-related AEs were observed in participants receiving islatravir. PK analysis demonstrated that the lowest level concentrations between doses of islatravir triphosphate in PBMCs following either dosage level remained above the pre-specified PK threshold for HIV-1 prophylaxis of 0.05 pmol/106 PBMCs. These levels were sustained through 8 weeks following the final dose. “The 24-week analysis of investigational, once-monthly oral islatravir not only builds upon the PK data we have already seen, but also provides encouraging support for the safety and tolerability profile of this HIV-1 PrEP regimen,” said Joan Butterton, MD, vice president of global clinical development for infectious diseases at Merck Research Laboratories, in a press release. “As part of our commitment to understanding the potential for our HIV medicines in a broad range of patients, we focused on the enrollment of diverse patient populations at risk for HIV, including women, who have one of the highest unmet needs in HIV prevention.”
REFERENCE
Merck Presents New Data from Ongoing Phase 2a Clinical Trial Evaluating the Safety, Tolerability and Pharmacokinetics of Investigational, Once-Monthly, Oral Islatravir for HIV-1 Prevention at IAS 2021 [news release]. Merck; July 20, 2021. Accessed July 23, 2021. https://www.merck.com/news/merck-presents-new-data-from-ongoing-phase-2a-clinical-trial-evaluating-the-safety-tolerability-and-pharmacokinetics-of-investigational-once-monthly-oral-islatravir-for-hiv-1-prevention-at-ias-2021/
Related Content:

Clinical Trial Shows Safety, Efficacy of Monthly Oral Islatravir for HIV-1 Prevention

July 27, 2021
The combination drug regimen of dolutegravir and lamivudine (Dovato, ViiV Healthcare) demonstrated non-inferior efficacy compared to the continuation of a current antiretroviral regimen (CAR) of at least 3 drugs, according to 48-week data from the SALSA study presented at the International AIDS Society Conference 2021. The drug also resulted in zero cases of virologic failure and no development of resistance in virologically suppressed adults with HIV-1 who have not previously experienced virologic failure. “It is exciting to have more data re-affirming Dovato’s efficacy and positive barrier against resistance development, showing that people can keep their HIV under control while taking fewer medicines,” said Josep Llibre, MD, PhD, in a press release. “The results are particularly meaningful given that the SALSA trial demographics represent the people living with HIV that we see in daily practice, including women, people over 50 years old and a range of different ethnic groups. These findings give physicians another reason to feel confident switching virologically suppressed people to this 2-drug regimen.”
The SALSA study population is diverse and provides representation for a broad population of individuals living with HIV on a variety of different regimens of at least 3 drugs, according to the study authors. Participants were gathered from more than 120 study sites globally, from a variety of racial backgrounds and with a significant portion of these patients being female (39%) and 50 years of age or over (39%). “At ViiV Healthcare, we are committed to ensuring our clinical trials are diverse and representative of the global HIV community; this study is an excellent example of that, and it is exciting to see that the results continue to be outstanding,” said Kimberly Smith, MD, head of Research and Development at ViiV healthcare, in the release. “SALSA is the second switch study to demonstrate Dovato’s non-inferior efficacy and high barrier to resistance, with no participants experiencing virologic failure in the Dovato arm of the study. These findings demonstrate its versatility for participants who had previously been on a broad range of different regimens, cementing its place in the HIV treatment paradigm.”
Adverse event (AE) rates were similar between the dolutegravir/lamivudine and CAR arms at 73% and 70%, respectively. Rates of AEs rarely led to study withdrawal in either arm, with a 2% withdrawal rate in the dolutegravir/lamivudine arm and a 1% withdrawal rate in the CAR arm. The most common AEs in the dolutegravir/lamivudine arm were weight increase (8%), headache (7%), and COVID-19 (6%), whereas headache (7%), upper respiratory tract infection (6%), and COVID-19 (4%) were most common in the CAR arm. REFERENCE
ViiV Healthcare presents data from second Dovato (dolutegravir/lamivudine) switch study confirming non-inferior efficacy and no virologic failure versus a broad range of regimens of at least 3 drugs [news release]. GSK; July 17, 2021. Accessed July 22, 2021. https://www.gsk.com/en-gb/media/press-releases/viiv-healthcare-presents-data-from-second-dovato-switch-study/
Related Content:

Two-Drug Combination of Dolutegravir and Lamivudine Equally Effective in HIV Treatment as Existing Therapies

John Wiley & Sons provides content-enabled solutions that improve outcomes in research, education, and professional practice. The company's core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Wiley

Wiley and International AIDS Society Confirm New Publishing Partnership - News

International AIDS Society (IAS) is an association of HIV professionals. The company advocates and drives action to reduce the impact of HIV. It is based in Geneva, Switzerland.

Wells Fargo Success Story

3M Success Story

Platform Overview

International AIDS Society

Work for International AIDS Society?

Compete with International AIDS Society?

Work for International AIDS Society?

Discover the right solution for your team