What to expect from ART by 2020

 Link to conference summary by Tripp Gurlick now on line, an excellent overview: http://aps.mediasite.com/mediasite/Play/467fcbe8af2d44f1997197f49161d4b21d 

Trip Gulick gave a truly excellent summation of both presentations at the conference and also what can be expected in the future of HIV therapy. I strongly recommend that once the webcasts become available http://hivglasgow.org/ you watch this presentation. I cannot do it justice, but in 20 minutes six key concepts were covered and importantly the contributions they might make to improved HIV treatment by 2020:

Activity

The capacity of a drug to have physiological impact, “may be maxed out at 90%”. Conceptually the drugs might be as active or as near active as they can be. Not an area that was identified as one where great leaps can be made.

Safety and Tolerance

Both areas where a lot of movement has been made but ones identified where work can  and still is being done. Dose reduction (reported on by Di Carey from the Kirby Institute with respect to EFV) and newer formulations such as is the case with TAF (the newer formulation of Tenofovir with improve renal tolerance).

Convenience

An area in which there is likely to be continued improvement. There are now 4 single pill regimens and more will emerge. Interestingly this was an area which was questioned during the conference where convenience was seen as an area for possible trade for cost.

Affordability

This is the area of continued and emerging contention. While this presentation focused on HIV, much of the discussion at the conference on hepatitis C focused on cost. Annual ART in developing countries is approaching $139 per annum. Costs will continue to come down as new compounds are introduced.

Accessibility

Greater access to treatment earlier is the goal and a dimension in which improvement is anticipated. Identification of the undiagnosed is important as is earlier commencement of treatment. But this was framed in a context in developed countries where treatment is delayed and late diagnoses common.

Life expectancy

This was a very interesting if not unexpected analysis. Based on CHIC and D:A:Ds data life expectancy of people living with HIV has greatly increased. This may not be able to be improved much. An otherwise healthy young person, infected today might have a life expectancy in their mid 70s this compares well to averages (men 78 – women 82). If they start treatment at a CD4 above 350 this is estimated to go up to 89 years. That is considerably better than the average and naturally it relates to their engagement with the patient’s life long health system and access to other preventative and restorative health care. So again an area in which we might be maxed out as far as future benefits are concerned.

But please do look at this and the other online presentations when they become available http://hivglasgow.org/ This may be a little while as they go into post-production, but most of the presentations will be put online.