Recap and Highlights From CROI 2015
April 21, 2015
The annual Conference on Retroviruses and Opportunistic Infections (CROI) was held in Seattle, Washington from February 23 through February 26, 2015. CROI provides an opportunity to learn about the latest developments and research questions in the field of HIV, hepatitis C (HCV), and related viruses. Among this year's approximately 4,000 attendees were researchers, clinicians, advocates, and policy makers from across the globe. Highlights of the conference are presented below, by topic:
Table of Contents
Where We Stand
According to David Cooper's plenary presentation, 13.6 million people living with HIV (HIV+) globally are receiving HIV drugs, while 28.6 million HIV+ people should be getting them based on the World Health Organization's (WHO) treatment guidelines.
PEPFAR Update: Flat Funding and Targeted Spending
Although there is a demonstrated need for more people to receive HIV treatment, funding from the US President's Emergency Fund for AIDS Relief (PEPFAR) and the Global Fund is currently flat. That is, funding from these agencies is not projected to increase in proportion to the increasing need for treatment.
Consequently, PEPFAR Ambassador Deborah Birx emphasized an evidence-based shift of resources to where HIV is -- a geographically and demographically targeted approach to HIV treatment and prevention efforts. This approach is meant to make the most efficient use of resources to end the epidemic.
Early Treatment Prevents Serious Illness and Death
The Temprano study looked at starting HIV treatment earlier -- for those with CD4 counts above 500 vs. the WHO standard -- in a resource-limited area. The study showed a 44 percent reduction in serious illness and death among those who began treatment early. These results support claims that the HIV treatment guidelines should be changed to reflect that HIV treatment should be made available to all people living with HIV.
"Weekend Off" Treatment Encouraging for Youth
Among adolescents, for whom treatment adherence is often more challenging than for adults, researchers in Ireland looked at a "week-on, weekend-off" plan. Unlike other treatment interruption trials in which viral rebound was allowed, in this study participants were taking a break from their HIV drugs with the hope that the break would enhance their adherence and viral suppression. The BREATHER study was conducted among 199 young people ages 8 to 24 years in Europe, Argentina, Uganda, Thailand, and the US.
Researchers found that the plan was highly acceptable to young people and appeared safe. Despite being very encouraged, researchers suggested that their results should not yet impact clinical practice, as a two-year follow up of longer-term outcomes is in progress.
TAF: Cousin of Tenofovir Just as Effective, With Less Risk of Bone and Kidney Problems
Tenofovir alafenamide (TAF) is a new 'cousin' to the older and well-known tenofovir disoproxil fumarate (TDF, or Viread). TAF has higher concentrations in cells and lower concentrations in the blood. Therefore, it presumably brings greater amounts of the drug to HIV-infected cells while reducing side effects.
One study showed that a combination of drugs including TAF was just as effective and well-tolerated as the same combination including TDF. The most common side effects were diarrhea, nausea, and headache; these side effects occurred equally in the TAF and TDF groups. Researchers concluded that their results support the single-tablet combination of emtricitabine, elvitegravir, cobicistat, and TAF as a new option for those beginning treatment for HIV.
A similar study compared the effects of TAF to TDF on kidney and bone health. This study found that TAF had less of a negative effect on kidney function and on bone mineral density (a measure of bone strength) than TDF. TAF also appeared to increase blood fats to a lesser degree than TDF. While longer-term effects of TAF-containing regimens are not yet known, these studies suggest that TAF may be safer and better-tolerated that TDF, which is important given the need for long-term treatment in the growing aging HIV population.
Promising New Maturation Inhibitor (BMS-955176)
Bristol-Myers Squibb showed promising results from an early (phase 2a) trial of an HIV maturation inhibitor, BMS-955176. Maturation inhibitors prevent the virus from maturing within the cell, which means that viral particles that are released have not completed their life cycle and are not infectious. People who have drug-resistant strains of HIV or are treatment-experienced may find drugs like BMS-955176 especially important, since it works in ways that none of the currently approved drugs do.
The drug appears to be both effective at reducing HIV viral load and safe (no deaths, serious adverse events, or discontinuations). It is important to note that none of the 60 study participants were women. Phase 2b trials are planned in the near future.
This article was provided by The Well Project. It is a part of the publication The 22nd Conference on Retroviruses and Opportunistic Infections (CROI 2015). Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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