New Data on Effective Treatments for Patients with HIV

Panel discussion of study results presented at IAS 2013 focusing on strategies for using antiretroviral therapy (ART) in patients with HIV who are ART-naïve or who have failed previous therapies.

In this press conference from the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013), several experts present information about five late-breaking study abstracts that focus on strategies for using antiretroviral therapy (ART) in patients with HIV. Two of the studies focus on first-line treatment in ART-naïve patients, while the other three focus on treating patients who have failed previous therapies.

Rebekah Puls, BSc, PhD, senior lecturer at The Kirby Institute, University of New South Wales, Sydney, Australia, discussed results from A daily dose of 400mg efavirenz (EFV) is non-inferior to the standard 600mg dose: week 48 data from the ENCORE1 study, a randomised, double-blind, placebo controlled, non-inferiority trial.” In the ENCORE1 study, ART-naïve HIV-infected adults with no prior AIDS were randomized to receive either standard dose efavirenz (EFV) plus emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) or a lower dose of EFV (400 mg) plus TDF/FTC. Analysis of data demonstrated that low-dose EFV plus TDF/FTC was non-inferior to the standard dose combination treatment and was associated with fewer EFV-related side effects.

Somnuek Sungkanuparph, MD, professor of medicine at Ramathibodi Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand, discussed results from “HLA-B*35:05 and CCHCR1 screening reduces nevirapine-associated cutaneous adverse reactions in Thailand: a prospective multicenter randomized controlled trial.” This study was designed to determine the effectiveness of prospective genotypes-based screening to prevent nevirapine-associated cutaneous adverse reactions (NVP-CAR) in treatment-naïve HIV-infected patients. In the study, HLA-B*3505 and CCHCR1 SNPs genotyping reduced the risk of NVP-CAR in this patient population.

Pedro Cahn, MD, PhD, Scientific Director and president of Fundacion Huesped, Buenos Aires, Argentina, presented information on “Dolutegravir is superior to raltegravir in ART-experienced, integrase naive subjects: week 48 results from SAILING (ING111762).” The study compared the investigational integrase inhibitor (INI) dolutegravir to raltegravir in INI-naive patients with 2 class resistance or greater and ongoing virologic replication. The study found that dolutegravir was superior to raltegravir in INI-naive, treatment-experienced subjects through 48 weeks, with significantly less emergent resistance and similar safety and tolerability.

Nicholas Paton, MD, FRCP, of the MRC Clinical Trials Unit, London, UK, discussed results from “A pragmatic randomised controlled strategy trial of three second-line treatment options for use in public health rollout programme settings: the Europe-Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial.” The study compared Nucleotide Reverse Transcriptase Inhibitors (NRTI) plus boosted PI (bPI) backbone with raltegravir (RAL) plus boosted PI (bPI) backbone for second-line therapy in adult patients who met WHO-defined treatment failure criteria after more than 12 months on NNRTI-based first-line treatment. The researchers reported that bPI plus RAL did not show clear superiority to bPI plus 2NRTI at week 96. Also, bPI monotherapy was non-inferior on the primary endpoint.

Jennifer Hoy, MBBS, Monash University, Melbourne, Australia, discussed “Changes in bone mineral density over 48 weeks among participants randomised to either lopinavir/ritonavir (LPV/r) + 2-3N(t)RTI or LPV/r + raltegravir as second-line therapy: a sub-study of the SECONDLINE trial.” This study found that a regimin of lopinavir/ritonavir (LPV/r) + raltegravir as second-line therapy is associated with less bone loss than a regimen containing N(t)RTIs.

Study abstracts, presentation slides, and additional video are available on the IAS website.

Image by Photo©International AIDS Society/Steve Forrest/Workers' Photos