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.

The future of antiretroviral therapy

Posted by on in New ARV Treatment, clinical trials emerging therapy
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Roy Gulick, from the Division of Infectious Diseases, Weill Cornell Medical College, New York City, gave answers to the question "What next for ARVs?" during his presentation today.

But before we talk about the future, let's pause and look at ART in the year 2016:

  • When to start:
  • Currently 29 approved drugs:
    • From five broad mechanistic classes:
      • EI, NRTI, NNRTI, PI & INSTI
  • We currently have up to 10 recommended first-line regimens:
    • 1 standard strategy: 2 NRTI + [NNRTI, PI or INSTI]
  • Properties of ART:
    • Virologic activity
    • Safety and tolerability
    • Convenience
    • Access and cost
    • Life expectancy

 

Newer strategies, formulations and investigational ARV agents:

  • Long acting compounds under investigation:
    • Injectable formulation of the NNRTI, Rilpivirine LA (long acting)
    • Injectable formulation of a new INSTI, Cabotegravir
  • Formulations of implantable devices that provide sustained release of ARVs
  • A new NNRTI, Doravirine (DOR):
    • Active agains drug-resistant strains
    • In vitro active against viral strains with K103N, Y181C, G190A, E101K, E138K or K103N/Y181C
  • A new INSTI, Bictegravir:
    • In vitro active agains viral strains with integrase resistance
  • Two new mechanistic classes under investigation and in clinical development:
    • An oral CD4 attachement inhibitor, BMS-663068:
      • BMS-663068 is a prodrug of BMS-626529 an inhibits CD4 binding to gp120 
    • HIV maturation inhibitor (MI), BMS-955176:
      • Binds tightly to HIV GAG
      • In vitro active agains strains with polymorphisms and PI resistance

There has also been a lot of talk at the conference about two-drug regimens and Dolutegravir monotherapy, but until we have conclusive data to support the efficacy, three-drug regimens remain the current gold standard.

Conclusion:

Currently, we can control HIV infection long-term with potent, safe and convenient ART that leads to prolonged healthy survival in our patients. The development of newer drugs and new drug classes opens up options for patients with multiple resistances. 

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Guest Monday, 23 April 2018

RT @jasongrebely: There is two weeks until the abstract deadline for the @INHepSU 7th International Symposium on Hepatitis in Substance Use…

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