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CROI 2014 Preview: Hot Topics in HIV and Hepatitis Research

February 27, 2014

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Benjamin Young, M.D., Ph.D.

Benjamin Young, M.D., Ph.D., vice president and chief medical officer of the International Association of Providers of AIDS Care

It's that time of the year again. Like a circadian rhythm, cold, gray skies remind me of winter days working in a Russian HIV hospital, but my internal clock also says that it's time for the Conference on Retroviruses and Opportunistic Infections (CROI). Like most years, it seems, this year's meeting takes place in Boston, where the polar vortex meets university learning.

But while it might be cold outside, CROI is the meeting for presentation of the hottest scientific findings on HIV topics.

What are the topics that I expect will heat things up this year?

New Hepatitis C (HCV) Treatments

A new era in the treatment and cure of hepatitis C is upon us. With last year's U.S. Food and Drug Administration (FDA) approval of sofosbuvir (Sovaldi), a time in which short-course, interferon-free, curative treatment for most people living with HCV (and HCV/HIV coinfection) has become possible. Indeed, if we successfully diagnose and link to care people living with HCV, we can begin to imagine control of the HCV epidemic.

CROI will start off with an HCV bang, with several presentations highlighting data on recently approved and investigational medications in studies with names even catchier than most HIV studies, including PEARL (a study of combination therapy with Abbvie's investigational HCV medications), SYNERGY and PHOTON (a study of sofosbuvir in an all-oral regimen with ribavirin in coinfected persons). Other studies will also point to the potential of all-oral, interferon-free treatments.

Antiretroviral Therapy: Important Strategy Studies

So, we've got good drugs to treat HIV. But which drugs should we use? And can we break free of the mantra that we must always prescribe two nukes plus a third drug? How about very long-acting, injectable regimens -- can they be viable?


Just last year, we learned that in two large clinical studies, the integrase inhibitor dolutegravir (Tivicay) was superior to officially recommended regimens using either the industry behemoth efavirenz (Sustiva, Stocrin) or boosted darunavir (Prezista). Those official recommendations -- the U.S. Department of Health and Human Services' (DHHS) expert panel guidelines regarding antiretroviral therapy in adults and adolescents -- ultimately went on to add regimens containing dolutegravir and elvitegravir (another integrase inhibitor, part of the four-in-one drug Stribild) to its elite "preferred" status for first-line treatment, alongside raltegravir-containing regimens. Together, these developments suggest that the standard of care and side effect burden of current treatments may be evolving for the better.

At this year's CROI, we'll learn from AIDS Clinical Trials Group researchers the results of ACTG 5257, a massive NNRTI-sparing study involving first-line treatment with tenofovir/emtricitabine (Truvada), in which patients were randomly assigned to receive that drug along with boosted atazanavir (Reyataz), boosted darunavir or raltegravir. I'm told the results are going to have blockbuster importance.

Similarly, I'm looking forward to seeing results of the NEAT001 study -- a huge, non-industry sponsored study comparing the nuke-sparing regimen of raltegravir and boosted darunavir to the conventional (and DHHS-preferred) regimen of tenofovir/emtricitabine and boosted darunavir. The authors are expected to report that the nuke-sparing regimen is non-inferior.

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This article was provided by TheBodyPRO.

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