The Conference on Retroviruses and Opportunistic Infections reports important advances in HIV treatments and clinicalPertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. care. The 18th CROI was held in Boston in March. Neil McKellar-Stewart highlights some of the good bits.
Newer drugs are effective salvage[salvage therapy] A treatment strategy for managing HIV in people who have developed resistance to existing therapies.
In one study, 100 PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA. with multiple drug resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. were each given a combination trio of the newer antiretroviralsA medication or other substance which is active against retroviruses such as HIV. - raltegravir, etravirine and darunavir/r. Most of those in the study had been on treatment for over 13 years and twenty of them had received an AIDS diagnosis in the past. At the start of the study their median CD4 counts were around 250, their lowest ever CD4 was 80 and their average viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. around 16,000.
After 96 weeks, 90% of them maintained undetectable viral loads. This is good news considering how much resistance they had shown at the start of the study. There were no major side effects (like changes in lipidA fat. levels) and they increased their CD4 count by an average of 180.
This study shows that people who are struggling to achieve an undetectable viral load may do better on this new regimen
Dolutegravir looking good after initial concerns
The VIKING II study of the new second generation integrase inhibitor, dolutegravir, studied people who were very treatment experienced, who had viral loads greater than 1,000 copies and who had resistance to the integrase inhibitor, raltegravir.
Initial trials using dolutegravir once daily were unsuccessful, but when the dosing was increased to twice-daily it seemed to be more effective. Nearly all (96%) of the participants taking the drug achieved undetectable viral loads. These good results open the way for further trials to confirm whether it performs equally as well over a longer period.
Good news for treating HCVHepatitis C virus. and HIV together
Having hepatitis C (HCV) and HIV together can mean some complicated treatment choices.
However, the new HCV drug, telaprevir (TVR) appears to perform well in combination with pegylated-interferon (PR) and HIV meds.
The reported study had three separate arms: TVR+PR without HIV meds; TVR + PR + Atripla; and TVR + PR + Truvada + atazanavir/r. All these drug combinations were compared to standard treatment (PR) without TVR.
The people in the study had HCV viral loads greater than 600,000 and 10% of them had advanced liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. fibrosis.
TVR was taken every 8 hours with food and dosed for the first 12 weeks of HCV treatment (which normally continues for another 36 weeks to achieve clearance of HCV). But by week 4, 70% of people taking TVR had undetectable HCV. This is known as a rapid virological response (RVR) and indicates that there’s a 90% probability of these people clearing their HCV.
More of those also taking Atripla (which contains efavirenz) than those taking atazanavir achieved undetectable HCV (75% compared to 64%). Only 14% of people who didn’t take any TVR (just the standard treatment PR) achieved undetectable HCV. What’s more, taking HCV treatment along with HIV antiretrovirals appeared not to affect how well their HIV was controlled.
These are excellent results and hold out lots of promise for better treatment for people with both HIV and HCV.
Tesamorelin reduces gut fat, may improve bone mass
A drug approved late last year in the US to treat excess ‘gut’ fat or visceral adipose tissue (VAT) appears to also improve bone mass. Many PHIV experience the former as a symptom of HIV-related lipoatrophy and many of us also have an increased risk of bone mass loss (sometimes called osteopenia).
Tesamorelin (Egrifta) stimulates the pituitary gland to release growth hormone which can reduce visceral fat. In a trial it was found to reduce VAT by 18% over 52 weeks.
The study followed 412 people receiving HIV treatment for 26 weeks and found that tesamorelin increased bone tissue production as measured by some key blood markers. This is an interesting finding which may lead to further research on the action of this drug in stimulating bone mass increases.
The presentations (oral papers and posters) may be seen by going to the CROI website
In addition, all the major HIV information services have reported on CROI, check out these sites: