IAS 2019 Conference Update
REPORT FROM MEXICO CITY
French data suggest that a four-day-a-week regimen works as well as taking meds every day—but don’t try this at home
Researchers reported that people taking their HIV medications just four days a week did as well as people in the study who continued taking their antivirals every day.
People living with HIV had asked if it was possible they could stop taking their meds on weekends. At the same time, some of the newer HIV meds last a longer time in the body, and a break might be possible.
So said Roland Landman, MD, at a press conference where he presented results on behalf of the French national HIV research organization ANRS.
After a year of study ANRS researchers have declared that the four-days-a-week strategy was non-inferior to (just as good as) daily therapy.
For the four-day group, 95.6% of participants achieved undetectable viral load (less than 50 copies). In the daily group, 97.2% were undetectable.
Longer-term data are needed to determine what effect four-day-a-week dosing would have on viral reservoirs (hiding places) and co-morbidities. Plus, adherence would be even more of an issue if you were to miss a dose or had background drug resistance.
The ANRS 170 QUATUOR study (Abstract 4817) enrolled 318 participants in each group.
Two years with Dovato
The 2-in-1 single-tablet regimen (STR) Dovato (dolutegravir/lamivudine) carried forward its good results out to two years.
The GEMINI 1 and 2 studies found that Dovato remained non-inferior to a traditional three-drug combination. There were 1,400 participants in the trials.
Switching to Dovato
Switching from a three-drug combination to the two-drug combo of Dovato was successful for participants in the TANGO study.
Half of the 741 participants were switched to Dovato. At the end of six months, they maintained their undetectable viral load as well as the group that remained on three drugs.
TANGO will continue out to 148 weeks (three years).
Descovy for PrEP
The DISCOVER trial earlier reported having found Descovy non-inferior for HIV prevention when compared to Truvada for PrEP.
Now the study reported that a sub-analysis has also found Descovy “reached intracellular drug concentration levels above the estimated protective threshold significantly more quickly than Truvada” and “additional pharmacokinetic data confirm that these drug concentration levels persist longer than Truvada.”
Although Descovy is a newer version of Truvada, the two drugs work in slightly different ways. As this issue went to press, Truvada for PrEP is the only HIV prevention medication on the market. The FDA is expected to approve Descovy for use as PrEP sometime this year.
MK-8591: A new HIV drug...
Good early results for HIV treatment were seen with MK-8591, also known as islatravir.
At six months, the 121 participants in the study all had continuing tolerability to different doses of the drug.
They also had good treatment results, as shown by undetectable viral load, in combination with doravirine and lamivudine, two drugs already on the market. For the three different doses studied, the percent of participants who were undetectable was 87.1%, 89.7%, and 100%.
MK-8591 is an HIV medication from a new drug class, called nucleoside reverse transcriptase translocation inhibitors (NRTTIs).
... and a new PrEP implant
Merck & Co. also reported that its experimental medication may be suitable for a PrEP implant lasting one year.
The company found an MK-8591 implant tolerable in early research with primates. Drug levels showed adequate concentrations for protection against HIV.
New long-acting HIV drug, GS-6207
Gilead Sciences reported strong antiviral results over 10 days with a single subcutaneous injection of GS-6207.
GS-6207 is from a new drug class; it is an HIV capsid inhibitor.
The company said that the early Phase 1b data are the first proof-of-concept that inhibiting HIV’s capsid (the protein shell of a virus) can lead to significant viral load drops in people (as opposed to in the test tube).
Three groups of six individuals living with HIV received one of three doses of GS-6207. Another group of six individuals were given a placebo (an inactive substance, for comparison).
The French still rock PrEP on demand
It was four years ago that French researchers reported equally good results between PrEP taken daily vs. PrEP on demand (taken around the time of sex).
Now the same group of researchers has a newer study that says the same thing.
The ANRS Prevenir community-based study in Paris lets men choose whether they will take Truvada for PrEP every day or around the time of sex.
More than 2,000 men were enrolled in the study between May 2017 and October 2018. More than half of them (56%) were already taking the daily HIV prevention pill.
After enrolling, that number dropped. The majority—53.3%—were now using PrEP on demand, while 46.7% went for the daily pill. Either way, there were no new cases of HIV. The research group said this supports continuing the use of both doses.
Read the research abstract at programme.ias2019.org/Abstract/Abstract/1057.
WHO adopts ‘2-1-1’ strategy
Following the ANRS Prevenir report, the World Health Organization (WHO) came out in support of PrEP on demand. It released a PrEP manual during the conference titled “What’s the 2-1-1?” “2-1-1” refers to taking two pills 2–24 hours before sex, followed by two pills afterwards (one within 24 hours of the two pills and another within 24 hours of the third pill).
“Based on the available evidence published so far, this technical brief updates the current WHO recommendation on oral PrEP to include an option of event-driven [time of sex] dosing for men who have sex with men,” the organization announced.
go to who.int/hiv/pub/prep/211/en.
The ANRS research summary noted that on-demand PrEP was already recommended as an alternative to daily PrEP by the guidelines of the European AIDS Clinical Society (EACS) and the International AIDS Society-USA (IAS-USA).
HIV Treatment = HIV Prevention
“Let me say something that we can firmly say right now that we could not say with a great deal of certitude a decade or more ago … we know very clearly by a number of studies that if you treat a person who’s [living] with HIV and bring down the level of virus to below detectable, that not only do you save the life of that person but you make it essentially impossible for that person to transmit the virus to another individual.”
—Anthony S. Fauci, MD,
Director of the National Institute of Allergy and Infectious Diseases