Emerging HIV Therapies

IAS2017 11 am Monday 14/7/2017

This session was about emerging therapies for HIV and new approaches to specific patient populations.  The topics covered in this session included immunodeficiency at the time of ART initiation and the use of various ART combinations in different settings such as advanced immunodeficiency, second-line ART resistance and the use of novel 2 and 3 drugs combinations in ART-naive individuals.

The first speaker, Nanina Anderegg showed that median CD4 count at ART initiation was <350 cells/µL, with >25% of individuals at CD4 count <200 cells/µL, in low, middle and high income countries in 2015.They analysed data from the International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, Latin America, Asia-Pacific and North America regions and from the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). They included all HIV-positive adults (≥16 years) initiating cART between 2002 and 2015.  This demonstrated that a substantial number of individuals still initiated ART at advanced immunodeficiency. Additional efforts and resources are needed to improve testing coverage, linkage to care, and ART initiation globally.  There was a general trend to start ART at higher CD4 counts in the later years of the study though, which is encouraging.

Lelièvre found that the addition of maraviroc (MVC) to standard ART in advanced HIV infection had no impact on the risk of occurrence of infections, serious events and mortality, virological control or CD4 count recovery.  However, post hoc analysis showed a trend for a beneficial effect of the addition of MVC in the first 24 weeks in CD4 count recovery that disappeared thereafter.  Therefore miraviroc may be of some benefit in immune system reconstitution in early stages of therapy.

 Moh reported that in individuals failing second-line PI-based regimens, a phase of intense adherence reinforcement with HIV-RNA monitoring may help determine whether switching to a third-line regimen is required. 

 Joel Gallant showed that bictegravir/emtricitabine/tenofovir alafenamide was non-inferior to dolutegravir/abacavir/lamivudine in terms of virologic efficacy and was well tolerated. This was in treatment naïve subjects and their data extends to 48 weeks.  The single-tablet formulation bictegravir/emtricitabine/tenofovir alafenamide is potentially suited to the setting of same day/rapid ART initiation as it can be safe to start pending hepatitis B screening results, has high virological efficacy and favourable safety profile.  This study is ongoing.

In other treatment-naïve individuals, simplified combinations such as ritonavir-boosted darunavir/lamivudine was shown to be non-inferior to ritonavir-boosted darunavir/lamividuine/tenofovir in achieving HIV-RNA <400 copies/mL at week 24 as presented by Pedro Cahn.  Dolutegravir/lamivudine also demonstrated potent virologic efficacy at week 24 in individuals with entry HIV-RNA <500,000 copies/mL thanks to data presented by Babafemi Taiwo.  Early data suggest that simplified regimens consisting of ART with a high resistance barrier and lamivudine may be non-inferior in virologic control in treatment-naïve individuals. Data with larger sample sizes and longer follow-up are needed to confirm these findings.