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 HIV Therapy
The Future of HIV Therapy
Dr Roy Gulick (Professor of Medicine and Chief of the Division of Infectious Diseases at Weill Medical College of Cornell University) from New York provided a great summary of current treatment guidelines and new developments underway with ART.
In summary:
ART is now recommended to commence at any CD4 count when a patient is also ready to start. If resources are a priority then treatment should be offered first to those with a CD4 <350.
There are currently 29 approved HIV medications and up to 10 starting regimes.
5 broad mechanistic classes (NRTI, NNRTI, PI, INSTI,EI)
Recommended standard strategy is 2NRTI +(NNRTI,PI,or INSTI)
If there is multiclass failure to the 29 drugs two new entry inhibitor class drugs are showing promise.
1 Fostemsavir (oral HIV attachment inhibitor with Phase 2 results soon to be released)
2 Ibalizumab (monoclonal antibody given parenteral, binds to CD4 receptor/works as HIV entry inhibitor)
2 New classes of HIV Rx being developed:
1 HIV Maturation Inhibitors
2 HIV Capsid Inhibitors
Newer approaches to safety and tolerability in the future ART include:
Using lower doses of drug eg (EFV 400mg vs 600mg). Other studies in progress are ATV 300mg, DRV 400mg
Newer drugs eg tenofovir alafenamide(TAF). Switching TDF to TAF improved renal/bone markers
2 Drug regimes: PI/r+3TC (or FTC), PI/r+ integrase inhibitor, NNRTI +integrase inhibitor , DTG+3TC/Paddle Study(results showed VL all suppressed by 8 wks)
Less frequent dosing eg RAL daily formulation
New co formulations eg ATV/c and DRV/c
New injectable drugs RPV LA, Cabotegravir
Latte 2 study is looking at IM CAB +IM RPV with conclusions showing IM is comparable to PO and well tolerated. Phase 3 studies are evaluating IM q4wks.
Dr Gulick concluded by saying that future ART Rx will involve greater use of sub dermal implants and injections with potentials for dosing going from weekly up to every 1-3 months. Costs will radically decline and affordability improve. Convenience will also continue to improve. We have already seen the dosing levels of 20 tablets a day reduce to one a day in the last 10 years. Interestingly life expectancy in ART uses from recent studies in US, Canada and UK were showing higher figures than for the average population! Presumably regular medical intervention can be a good thing for our species!