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.
New developments in the treatment of HIV
This was a poster presentation session focussing on new drugs and new strategies for the treatment of people living with HIV. I will focus on results relevant to MSM populations.
The first presenter was from Thailand. T. Bunupuradah reported on results from a trial comparing 200 mg of boosted atavanavir to 300 mg of boosted atazanavir in virologic suppressed HIV-infected Thai adults. This was a randomised, open-label trial. He showed that the lower dose atazanavir is non-inferior in terms of efficacy. There was higher discontinuation due to intolerance in the 300 mg group. there is difficulty extrapolating these results to other ethnicities though due to possible weight and genetic differences. These results could not be generalised to treatment naive or those failing first line therapy either.
The second speaker was Tony Mills from California. He presented data from a switching study which is at the 48 week mark. This study switched patients from a tenofovir disoproxil fumarate (TDF)-based regimen to a tenofovir alafenamide (TAF)-based regimen. The results are very encouraging for improved bone mineral density on the TAF based regimen. Before switching, patients were on elvitegravir, cobicistat, FTC and TDF (stribild), or efavirenz, FTC and TDF (atripla), or boosted atazanavir and truvada. They all had eGFR greater than 50. Then they were switched to elvitegravir, cobisitat, FTC and TAF or continued on their TDF-based regimen. I think this study was flawed however, given that in some patients the tenofovir component was not the only part of the regimen which was switched. This introduced a confounding factor into the analysis. Nonetheless, there was a significant increase in bone mineral density in the TAF group compared to the TDF-based regimens. The TAF group also maintained virologic suppression and showed a significant improvement in proteinuria and other markers of renal function Compared to the TDF group.
J. Gatell from Barcelona presented data on a new NNRTI doravirine at 100 mg once daily with a truvada backbone compared with efavirenz and truvada. The study authors saw a need for a new NNRTI given the CNS side effect profile of efavirenz. It was a double-blind study in ART-naive patients with HIV-1. At the 24 week mark, the doravirine group had less CNS adverse events than efavirenz. Furthermore, doravirine demonstrates similar viral suppression to efavirenz at the 24 week mark. This study is ongoing.
Finally, C. Hwang from BMS presented data on a second generation HIV-1 maturation inhibitor called BMS-955176. This was used in combination with boosted or unboosted atazanavir. The need for another class of drug is clear given treatment emergent or transmitted resistance. Newer drugs with fewer adverse events and less DDI's are still needed. Maturation inhibitors maybe beneficial in this context. BMS-955176 inhibits the last protease cleavage event between capsid protein p24 and spacer peptide 1 in Gag, resulting in the release of immature, non-infectious virions. The inclusion criteria of this study include HIV-1 subtype B-infected subjects. They were treatment naive or treatment experienced patients. It was conducted over a 28 day dosing period to asses the safety and tolerability of 176 and the change in plasma HIV RNA levels From baseline. 176 was generally wel tolerated with no SAEs or AEs leading to discontinuation. It also resulted in very good virologic response compared to standard of care. A phase 11b study is now underway in treatment experienced patients.