Focus on PrEP & Early ART: Highlights from IAS 2015

Last month, over 6,000 delegates from around the world gathered in Vancouver, British Columbia to hear the brightest and most influential HIV researchers, practitioners, advocates, community members and other thought leaders present the latest developments in HIV-related research and care.

BETA blog attended IAS 2015 to bring our audience interesting and relevant news reported at the conference. This year, PrEP research and implementation scored much attention, but late-breaking news on an HIV remission case, San Francisco demonstration project results, and HIV treatment updates also contributed to buzz in the HIV world. Below, see what you missed—and what grabbed headlines—at this year’s conference.

No Partner Infections with Viral Suppression in Landmark Treatment as Prevention Study

Myron Cohen, MD, presented final HPTN 052 clinical trial results—a landmark treatment as prevention study whose interim results were first shared publicly in 2011. This large-scale study of over 1,750 serodiscordant (mixed HIV-status) couples from nine countries demonstrated a 93% reduction in sexual HIV transmission risk with early successful antiretroviral therapy. Over the course of the study, there were a total of 46 HIV transmissions from the HIV-positive partner to the HIV-negative partner; none of the transmissions occurred when the person with HIV was stably suppressed on ART. The results have implications for future HIV prevention programs, said Cohen. “Special efforts should be made to minimize HIV transmission risk before viral suppression has been achieved, to maintain suppression on ART, and to identify and address ART failure.” Read more.  

Long-Term HIV Remission Case Raises More Questions than Answers

Much attention was paid to the case of a French teenager with HIV that has managed to stay off of ART with undetectable viral load for 12 years. Asier Saez-Cirion, PhD, shared that the young woman, who is now 18, was infected in-utero and immediately placed on preventative AZT soon after being born. After taking ART for six years, she was then withdrawn from care. A year later, after being off ART, her blood viral load was undetectable. While not thought of as a “cure,” the case is interesting since it may provide clues about how to help others achieve long-term remission. Read more.  

Definitive Proof of Early ART Benefit

Historically, HIV therapy has been withheld from people with HIV whose CD4 counts remained high. But recent evidence gives definitive proof that everyone—no matter how high their CD4 count is or how recently they have acquired HIV or have tested positive—should be on treatment.

Thousands of people packed an auditorium—standing in aisles and filling every available seat—to hear Jens Lundgren, MD, DMSc, give final results of the START study which enrolled over 4500 people with HIV in 35 countries worldwide. There was a 57% reduction in risk of developing an AIDS-related health problem, serious non-AIDS health problem, or death with immediate ART treatment. “IAS 2015 will be remembered as the definitive moment when the world agreed earlier initiation of treatment is the best way to preserve the health of people living with HIV, and one of the best tools we have to slow HIV transmission to others,” said conference co-chair Julio Montaner from the British Columbia Centre for Excellence in HIV/AIDS. Read more.  

Success of San Francisco’s Rapid ART Program

San Francisco’s RAPID program—which offers same-day linkage to care and ART for those who are newly diagnosed with HIV—was shared as an inventive and effective model of care by Christopher Pilcher, MD. Instead of an HIV diagnosis, initial assessment, counseling, medical evaluation and ART prescription being done over multiple visits, RAPID consolidates those things into a single visit. An evaluation found that this reduces the average time to achieve viral suppression from 119 days to 56 days. Early ART can limit the size of the viral reservoir and reduces risk of opportunistic illness. But getting people into care can be challenging, with people falling out of care at every stage, so interventions that help more people access and stay in care are crucial. Read more.

Intermittent PrEP—Will it Work for People?

Robert Grant, MD, MPH, along with 6 colleagues, shared results from the HPTN 067 “ADAPT” clinical trial that investigated how people may, or may not, benefit from time-based, event-based, and daily PrEP. People on PrEP want to be able to change how they take PrEP based on their sexual lives, and as they move in and out of periods of risk, said Grant, so evidence is needed to give people guidance. ADAPT found that time-driven PrEP (taking Truvada twice a week and once after sex) was feasible for men who have sex with men and transgender women at sites in Thailand, with high levels of adherence and good “coverage” of sex acts with PrEP. Young African-American men who have sex with men and transgender women in Harlem, New York, and young women in Cape Town, South Africa did better with daily dosing—with more doses missed in the time- and event-based dosing groups. Daily use of Truvada is the only FDA-approved way of taking PrEP. Read more.

New HIV Medications Could Stop HIV From Infecting Healthy Cells

Carey Hwang, MD from Bristol-Myers Squibb shared news of an experimental HIV drug called BMS-955176 recently tested in a Phase 2 study. The drug effectively suppressed viral loads when used in combination with a protease inhibitor. If approved, this would be the first drug in a new class of “maturation inhibitors,” which work by preventing HIV from assembling mature viruses that can infect other cells. Other presentations shared updates on a next-generation NNRTI called doravirine and a pro-drug version of TDF (Viread) called TAF. Read more.  

High Adherence in San Francisco PrEP Demo Project

Demonstration projects in San Francisco, Miami and Washington D.C. found 80-85% adherence to PrEP among men who have sex with men and transgender women, Albert Liu, MD, MPH reported. Non-adherence to the daily regimen of PrEP is problematic, but the high adherence reported from these “real-world” demonstration projects supports the scale-up of PrEP in clinical settings, said Liu. Drug adherence was measured using dried-blood spot analysis, a quantitative measure immune to bias or over-reporting. People with stable housing and those who reported greater exposure to HIV risk were more likely to adhere. “PrEP adherence was higher among those who reported higher risk behaviors which likely increased the cost effectiveness and impact of PrEP,” concluded Liu. Read more.

PrEP Adherence Challenges for Young Gay Black Men

Sybil Hosek, PhD, shared that the ATN 110 PrEP study, with young (age 18 to 22) men who have sex with men, found significant racial and ethnic group adherence differences. While white, Latino and mixed-race groups of participants reached adequate levels of PrEP coverage, African American men showed much lower levels of adherence. “Our African American participants, on average, did not reach the highly protective levels that PrEP can afford them at all across the course of the study,” Hosek explained. Because young black gay men in the U.S. are affected by HIV at much higher rates than other groups of people, PrEP may be an especially useful prevention strategy if adherence challenges are addressed. The study will, in the future, investigate why these differences appeared, to get a better understanding of how to help people overcome barriers to PrEP adherence. Read more.

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