The 21st International AIDS Conference (AIDS 2016) returned to Durban, South Africa July 18–22. It was 2000 when the conference first took place in a developing country—meeting in Durban.
More than 18,000 delegates attended this conference organized by the International AIDS Society (IAS), the leading independent association of HIV medical professionals.
The theme of this year’s conference was Access Equity Rights Now. Emphasis was given to addressing the needs of transgender people, men who have sex with men (MSM), and injection drug users at this year’s conference. View webcasts devoted to these populations online.
Following are a few of the highlights at AIDS 2016.
DUAL THERAPY STUDY
The PADDLE study showed good results for dolutegravir plus 3TC (DTG/3TC)—basically, Triumeq without abacavir. This was a two-drug combination used alone for one year. All 20 patients put on DTG/3TC reached undetectable viral load (less than 50 copies) at eight weeks. At 48 weeks, 90% (18 out of 20) had undetectable viral loads.
The advantages to dropping abacavir from the single-tablet drug combination is not having to take a genetic test to check for allergic sensitivity to abacavir and not having to deal with the lingering questions about abacavir’s potential effect on heart condition.
Isentress taken once a day was found to be non-inferior to its FDA approved twice-daily dose. The ON CEMRK study used a pill available only in research, a 600 mg formulation of raltegravir (brand name Isentress). Two of them were taken once a day. The approved Isentress dose is a 400 mg tablet taken twice a day.
Of the 732 participants reaching 48 weeks of study, 88% achieved undetectable viral load (less than 40 copies), whether they were given a once-daily or twice-daily raltegravir regimen.
LONG-ACTING INJECTION: CABOTEGRAVIR
A monthly shot (every four weeks) was chosen as the dose going forward into Phase 3 for research with the intramuscular injectable regimen of cabotegravir and rilpivirine in the LATT E-2 study. About 90% of nearly 300 people on one of three different doses had undetectable viral load of below 50 copies at 48 weeks. The treatment was considered well tolerated. LATT E-2 will also continue to evaluate an injection taken every eight weeks, however.
EPCLUSA IN HIV
Although the new hepatitis C virus (HCV) medication was approved by the FDA in July without a specific go-ahead for people who are also living with HIV, the drug continued to show good results in people who have both viruses.
The ASTRAL-5 study reported a 95% SVR (sustained virologic response, or cure) for the 106 coinfected participants in the study. The researchers reported that the medication was effective and well tolerated regardless of past treatment experience or cirrhosis.
HIV TREATMENT FOLLOWING PREGNANCY CONTINUES TO BENEFIT WOMEN
A large international study of 1,652 women found that staying on HIV therapy following pregnancy benefited them more than discontinuing the meds. They experienced fewer AIDSrelated complications than did the women randomized to stop their HIV treatment. There was a high rate of virologic failure, however, for nearly a quarter of the women, which the PROMISE 1077HS research team said was “underscoring the need to improve adherence.”
UNAIDS produced a report detailing the state of HIV around the world along with goals, such as “Zero Discrimination,” stating that, “Ignorance and misunderstanding continue to undermine efforts to end AIDS. In the worst cases, discriminatory attitudes and behaviors are facilitated by punitive laws and policies.” Read the report at unaids.org/ en/resources/documents/2016/ Global-AIDS-update-2016.
STIGMA PERSISTS IN THE ‘UNDETECTABLE’ ERA
“In an era of widespread HIV treatment and undetectable viral load, stigma remains a persistent feature in the lives of almost half of people living with diagnosed HIV in the UK, according to findings from The People Living with HIV Stigma Survey UK 2015,” reported Roger Pebody at aidsmap.com, the official news site of the conference. “Nevertheless the majority of people living with HIV score high on measures of psychological resilience, enabling them to cope better with stigma.” The anonymous online survey was filled out by 1,576 individuals. Read the report, which also covers other stigma reports at the conference, at aidsmap.com.
Prevention with PrEP
Prevention with the use of a daily pill again dominated an HIV conference. Several reports brought good news and not so good news on the use of Truvada (TDF/FT C) for PrEP (pre-exposure prophylaxis).
THE INTERNATIONAL TEAM behind the open label extension of the IPERGAY study reported that “Open-label on demand PrEP with oral TDF-FT C continued to be highly effective [97% risk reduction] in high risk MSM [men who have sex with men] to prevent HIV infection and had a good safety profile.”
IN MORE THAN 1,000 African couples with mixed HIV status, providing PrEP to the negative partner until the positive partner could begin antiviral treatment (shown to reduce infectiousness when undetectable viral levels are achieved) provided a 94% reduction in risk of transmission, according to the Partners Demonstration Project.
THE NUMBER OF people starting PrEP in the U.S. is greatest in the states with the most new HIV cases, but, “Despite positive trends in Truvada for PrEP use, utilization must increase to ensure lifetime risk seroconversion decreases in areas of high prevalence HIV in the U.S.,” reported Gilead Sciences, the maker of Truvada.
PrEP WITH TRUVADA needs to be studied in teenagers before it can be prescribed for them, but a U.S. study reported that of nearly 3,000 males ages 15 to 17 contacted for enrollment, only 260 were eligible, 152 refused participation, 108 were screened, and 79 enrolled. Then 40% of these (37 of the 79) dropped out of the study before week 48. “Non-adherent participants were significantly more likely than adherent participants to report worry that others would think they had HIV if they saw their PrEP pills,” lead author Sybil Hosek reported in an oral presentation.
A RESEARCH TEAM looking at six clinical trials and one demonstration project reported that “rapid third generation antibody tests are sufficient to minimize the overall risk of drug resistance from PrEP.” The report noted that drug resistance to one or both of the medications in the PrEP pill occurs primarily in people who have acute (new) HIV infection when starting or re-starting PrEP.
A NUMBER OF presentations looked at the biological reasons why PrEP has shown evidence of less effectiveness in women. Watch a webcast on the vaginal microbiome and more at programme.aids2016.org/Programme/ Session/1257.
What’s in a THEME?
The following is from AIDS 2016, which took as its theme “Access Equity Rights Now.”
Access Equity Rights Now is a call to action to work together and reach the people who still lack access to comprehensive treatment, prevention, care, and support services.
Access Equity Rights Now is a call to action to strengthen the commitment to HIV research evidence-based interventions.
Access Equity Rights Now is a call to action to all HIV stakeholders to unite and overcome injustices caused by violence and the exclusion of people on the basis of gender, class, race, nationality, age, geographic location, sexual orientation, and HIV status.
Access Equity Rights Now is a call to action to repeal laws that infringe on people’s human rights and deny communities the ability to participate in the world as equals.
Access Equity Rights Now reminds us that all our gains will be lost if we do not continue to push forward and build a strong global movement to change the course of the epidemic.