ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
ART Season 2
This was an oral abstract session focusing on some novel approaches to HIV treatment and modifying treatment in special risk groups.
Jean-Michel Molina presented some switch data from the EMERALD study, a randomized (2:1), open-label, international, multicenter, parallel-group, non-inferiority, 48-week study. Virologically suppressed individuals were switched from boosted-protease inhibitors (PI/r)+emtricitabine/TDF to darunavir/cobicistat/emtricitabine/tenofovir alafenamide (TAF). This showed good virologic efficacy and better bone and renal profile at the wk24 interim analysis.
Jose Gatell presented data from an elegant study focused on virologically suppressed individuals with high cardiovascular risk. They were aged 50 years or older and had Framingham cardiovascular risk greater than or equal to 10 percent. They switched from PI/r-based to dolutegravir-based regimen and showed non-inferior virologic efficacy with improvements in lipid profile at wk48. Other outcomes from this ongoing trial are awaited.
Laura Ciaffi showed data from a switching study. After viral suppression with second-line PI/r+NRTIs, maintenance with PI/r+lamivudine showed virologic efficacy at wk 96 despite the presence of the M184V mutation. This study was conducted in Africa. This is an example of the increasing number of dual therapy studies presented at IAS this year.
Kathleen Squires presented data comparing a fixed dose combination of doravirine/lamivudine/TDF to efavirenz/emtricitabine/TDF in treatment-naïve adults with HIV-1 infection. It showed non-inferiority at week 48 regardless of the baseline HIV RNA. Doravirine also showed superior neuropsychiatric and lipid profile in these results of the Phase 3 DRIVE-AHEAD study. A useful extension of this study would be a co-formulation of doravirine with FTC/TAF to reduce the renal and bone effects well known with TDF.
Micheal Aboud presented week 24 interim data from the DAWNING study. This looked at individuals with first-line NNRTI-based regimen failure. The superior efficacy of dolutegravir (DTG) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) compared with lopinavir/ritonavir (LPV/RTV) plus 2 NRTIs in second-line treatment was demonstrated.
Finally, Trevor Crowell presented data from a study using one of the newer approaches to HIV treatment, broadly neutralising antibodies. In virologically suppressed individuals who initiated ART during acute HIV infection, VRC01 was well-tolerated. However, VRC01 monotherapy was insufficient to maintain viral suppression. This is an early setback but this will benefit future research in this area. Broadly neutralising antibodies are being used in a growing area of research to assess alternative approaches to therapy besides daily oral therapy. On a more reflective note, another theme from the conference this year was to start treatment as soon as possible to reduce the potential viral reservoir which we know is concentrated in lymphoid tissues. This is likely to enhance prospects of cure or functional cure when future therapies become available.