Geneviève Fioraso est intervenue à l'occasion de l'International Aids Conference 2012, lors de la conférence plénière "Persistence and Eradiction", dédiée aux perspectives d‘éradication du V.I.H..
First of all, I would like to thank the organizers of this conference, the International AIDS society (I.A.S.) President, Elly Katabira, the co-chair Diana Havlir and the I.A.S.. Executive Director Bertrand Audoin, for their invitation to present the French perspective on Human Himmunodeficiency virus (H.I.V.) research, care and cure.
I am very happy with President Obama decision to reopen the doors of your great American Country to seropositive people. The location of this conference, here in Washington, is the best illustration of the US new policy regarding health and particularly H.I.V..
In 2010, the number of new H.I.V. infections totaled 2.7 million, 21% below the number at the peak of the epidemic. Yet, for each person who goes on treatment, two more are infected. At the end of two thousand ten, an estimated 34 million people were living with H.I.V. worldwide. AIDS mortality rates are declining globally, primarily due to antiretroviral therapy. Efforts to eliminate mother-to-child transmission are progressing well.
The search for a safe and effective H.I.V. vaccine has progressed further and faster in the last few years than at any time since the epidemic began. Results of the Thai trial presented at the AIDS Vaccine meeting in Paris in 2009, showed for the first time that a prophylactic vaccine candidate may prevent H.I.V. infections by 31,2%.
Recent progresses have shown that we can save millions of lives with the knowledge we have today. The evidence of the dramatic benefits of H.I.V. treatment as prevention, has dramatically change the landscape of the epidemic. These results allow a new optimism. It is indeed possible to have a much greater impact on these numbers and to turn tide the epidemic.
I recognize that for most of you, engaged on the fight against this epidemic for decades, this was an unthinkable scenario just a few years ago.
I would like to say here today that this goal is ours.
Since the start of the global epidemic, France has been deeply committed to the fight against H.I.V. and AIDS. This fight still remains a key priority at the French agenda as declared by the French President François Hollande at this conference.
In France, as in other countries, the objective now is to identify people infected with H.I.V. and to accompany them into efficient treatment as soon as possible. This is key, not only for preventing them from getting sick, but also for avoiding the risk they'll pass the virus on to others.
One estimates that approximately 150 000 people are living with H.I.V. in France; however it is estimated that there is an important and dangerous silent infection with 30 000 additional people who are unaware of their seropositive status. Approximately 7 000 people are still newly infected each year.
These new contaminations principally affect certain groups of populations, in particular men-who-have-sex-with-men and migrants. The specificity of the new infections naturally leads to well-defined questions that must be addressed by specific research projects. They aim to understand the dynamics of the new contaminations in these different groups. In this current context, novel prevention approaches and the implementation of H.I.V. testing and treatment are of utmost importance.
One another goal is also retention of patients on treatment to achieve undetectable viral load. The organization of the health system and the medical follow-up of H.I.V. patients in France results in more than 50% of infected people having an undetectable viral load. It is important to continue to work towards increasing this percentage. However, this figure is significantly higher than in a number of other resource-rich countries, including the U.S. where it is estimated that less than 30% of H.I.V.-infected individuals have undetectable viral load.
The organisation of H.I.V./AIDS research funding in France relies on the A.N.R.S. (French National Agency for research on AIDS and viral hepatitis). Today, France is the only country in Europe to have a specific national agency devoted to H.I.V. research.
We believe that this model is key for facing challenges of H.I.V. research and care. We will encourage to pursue the efforts on all aspects of H.I.V. research, from basic to social sciences and ethical aspects. In addition, the French research system has particularly encouraged translational research to bridge the gap between basic and clinical research.
As discussed in this session, research on H.I.V. reservoirs and cure is a key priority. Currently, there is no therapeutic option available other than continuous delivery of drugs aimed at preventing H.I.V. replication. Researchers have identified cellular reservoirs where the virus persists during continued antiretroviral therapy. However, the strategies that can be developed to eliminate these reservoirs or bring them under effective and persistent control, without the need for antiretroviral therapy, remain unclear.
For this project, let me thank the IAS, which has reunited a team of more than forty leading scientists and key stakeholders. They will contribute to the design of an international scientific strategy and solicit new ideas for making progress in developing a cure for H.I.V. infection.
The A.N.R.S. is a key partner of the International AIDS Society project, "Towards an H.I.V. Cure" led by Professor Françoise Barré-Sinoussi, I am happy to greet, and several French teams. I am pleased to announce here that National Institutes of Health (N.I.H.) and A.N.R.S. have signed during this conference an agreement to develop collaborations in this field.
I know that researchers need always to define new frontiers. However, I know that you are cautiously aware that we don’t know if this goal is realistic. The barriers are real but you must try. It is our responsibility to support researches in this area, but to do this without overpromises. I would like also to underscore that funding remain a problem and resources should not be diverted from other high priorities, such as the discovery of a safe and affordable vaccine, to accelerate access to treatment and to fight against discrimination and exclusion.
In the current context, I would like to encourage further research on new biomedical prevention approaches to reduce transmission of H.I.V.. France is currently involved in two major biomedical prevention programmes of Pre-Exposure Prophylaxis (PrEP) and treatment as prevention to assess the prophylactic effect of intermittent antiretroviral treatment.
In the field of vaccine research, we have developed a strong top-to-bottom vaccine research programme, which was recently awarded as a "Laboratory of Excellence", leading to the creation of the Vaccine Research Institute (V.R.I.). The institute regroups numerous research laboratories in France, Europe and in the U.S.. In particular, the V.R.I. has established a key public/private partnership to develop vaccines which target dendritic cells.
Besides basic science researches, I think that it is important to continue to improve simplification of antiretroviral treatments. Indeed more manageable treatment and fewer side effects, thus lead to a greater quality of life for people living with H.I.V.. Following the success of antiretroviral treatments and the subsequent improved survival of H.I.V.-infected individuals, the investigation on the role of H.I.V. in the accelerating ageing of H.I.V. infected people is key.
It is important to remember that all scientific advances and health care improvements are only possible with the continued financial commitment to the fight against H.I.V.. Today, we are closer than ever, to being able to implement the tools which could stop this epidemic. However, these tools are useless unless we have the financial means to implement them. Moreover we now have strong evidence that the fight against H.I.V. in resource-limited countries results in a general improvement of these countries’ health systems, extending its benefits to other diseases.
The international financial situation for H.I.V. research and care is in an extremely delicate situation. The renewal of the international commitment is more than ever essential. In this context, the French President François Hollande has proposed a European approach for supporting Growth. I would like to tell you that my department is working hard to convince that Research and innovation are major leverages for growth and competitiveness. I am also convinced that, in addition to the progress for Health and wellbeing, researches on H.I.V., prevention, cure and vaccines will also have economic impact.
France has been and remains at the forefront for H.I.V. research and international development in resource-limited countries. France is the second largest donor of the Global Fund to fight AIDS, tuberculosis and malaria. Its contribution is of three hundred sixty million Euros per year, at the second level in the world (exact?). Additionally, France contributed to the creation of Unitaid, which raises funds for H.I.V. treatment through the tax on airline tickets. However, we have to be innovative and to look at new ways of funding. President Hollande announced here on Monday his proposal to implement a financial transaction tax.
In conclusion, I will pay a particular attention that France remains committed to maintaining its key position in the H.I.V. research international landscape. I hope that new ideas, approaches and disciplines will enrich the current research context, in particular in the field of H.I.V. cure research and also in the development of prevention strategies including vaccines. Despite the current economic situation, France renews its commitment and engagement to ensure tangible progress in the fight against H.I.V./AIDS.
I would like to thank you for your attention and I wish you a very exciting and fruitful conference.