Tuesday plenary 2 - A great overview of the current situation and where we are headed

90 90 90 are high targets

Integrases will help achieve these higher proportion of fully suppressed patients for longer before resistance occurs and needing fewer regimen changes over the projected treatment period for some of 80 years.

Hurdles include

     -persisting treatment gap - those in care and not in therapy > 10 % in most clinic populations

     -whole life treatment from diagnosis despite

          -adverse events, pregnancy, childhood and adolescence, periods of poor adherence, drug interactions

     -Toxicity - but this is decreasing

              eg TDF will be replaced by TAF - lessening BMD loss and reducing proximal renal tubule issues

                   Duel therapies - eg Dolutegravir + 3TC - less exposureto potential toxicities

     - Resistance - but the use of potent therapies up front has made resistance rare

     - Are there enough agents to last 80 years

            New agents/ different classes will overcome resistance to previously used drugs

                         Dolutegravir

                         TAF

                         Doravirine

                         Maturation inhibitors

                         Attachment inhibitors

                         Monoclonal antibodies

     - Adherence issues - particularly at some stages in their life for some patients - adolescents and drug                   users for example - Long acting therapies like Cabotegravir and Rilpilvirine will help

               Drug implants

               Vector delivery