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Studies on emerging HIV treatment, important risks, and potential steps toward a cure were recently presented at the International AIDS Society (IAS) Conference 2021, resulting in this week's top trending clinical topic. A safety analysis of a new two-drug regimen for HIV treatment yielded encouraging results (see Infographic below). Islatravir (ISL) plus doravirine (DOR) was associated with short-lived, mild adverse effects (AEs). DOR, a nonnucleoside reverse transcriptase inhibitor (NNRTI), is currently approved and is part of the three-drug, single-pill regimen Delstrigo (doravirine/lamivudine/tenofovir disoproxil fumarate). ISL is still under development.
Combined with other data showing few changes in metabolic markers, this is potentially good news for people living with HIV, said Jean-Michel Molina, MD, PhD, who previously presented efficacy data on ISL/DOR at the HIV Glasgow 2020 Virtual Conference. Findings presented at IAS 2021 showed that over the first 96 weeks of the trial, only seven drug-related AEs were reported among patients in the ISL/DOR arm. All AEs occurred during the first 48 weeks, with none from weeks 48 to 96.
Even so, the value of ISL/DOR is muddled for Laura Waters, MD, consulting physician in HIV and sexual health at Central and Northwest London NHS Trust. Waters pointed out that the data are preliminary and that ISL has not yet been shown to lessen the chances of developing treatment-resistant mutations. That is important because early attempts at two-drug regimens resulted in incomplete suppression of the virus and resistance.
In regard to drug resistance, in a separate presentation, the long-acting drug lenacapavir was reported to show sustained viral suppression in a small cohort of heavily treatment-experienced patients with multidrug-resistant HIV at 26 weeks when combined with an optimized antiretroviral therapy. If approved, lenacapavir would be the only HIV-1 treatment option administered every 6 months. "These data support the use of lenacapavir in patients with multidrug-resistant viruses, and according to its long half-life of two subcutaneous injections per year, [it] could help reduce pill burden," first author Molina, told Medscape.
While presenting the updated findings from the phase 2/3 CAPELLA trial at IAS 2021, Molina underscored the need for longer-term treatments. "These patients with multidrug resistances are usually those who have not been fully adherent to their regimen," he said. "Being able to provide the drug, given every 6 months subcutaneously, provides an ideal treatment for overcoming resistance and lack of adherence."
Beyond treatment, a small study conducted in rhesus macaques may provide insight into a potential HIV cure. A 10-fold reduction in viral load was observed when the monkeys received immunotherapy to block programmed cell death protein–1 (PD-1) and the cytokine interleukin-10 (IL-10). This doesn't mean that IL-10 and PD-1 immunotherapy will cure HIV in humans, said Tim Schacker, MD, vice dean for research at the University of Minnesota Medical School, but it opens another door in the quest for functional cure. Schacker said the study will need to be replicated in humans and probably will need to be combined with others to truly control HIV.
Not all the news at IAS 2021 was positive, as a study presented at the conference found that HIV increases the risk for severe COVID-19 by 6% and the risk of dying due to COVID-19 in the hospital by 30%. The results come from the World Health Organization (WHO) Clinical Platform, which culls data from WHO member country surveillance as well as manual case reports from all over the world. By April 29, data on 268,412 people hospitalized with COVID-19 from 37 countries were reported to the platform. Of those, 22,640 people are from the United States.
From this concerning association to encouraging developments in treatments and the pursuit for a cure, HIV information presented at IAS 2021 resulted in this week's top trending clinical topic.
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Cite this: Ryan Syrek. Trending Clinical Topic: HIV - Medscape - Jul 30, 2021.