October 26, 2015
This blog discusses the implications for HIV-positive people of several studies at the 15th EACS conference in October 2015.
Last week at the 15th European AIDS Conference (EACS) in Barcelona, several research groups -- from Argentina, France, Spain and the Netherlands -- presented results from small independent pilot studies that have the potential to dramatically change HIV globally.
If the early results are supported by larger studies, the implications include the potential:
But these remarkably grand hopes need to be tempered with serious caution and patience. The current results are tentative, short-term and in small numbers of people. The results are exciting because our understanding of the dynamics of HIV mean that they shouldn't have happened, but they did -- and coming as a surprise means that even experts are unsure of their significance.
Further research will be essential before trying this at home or even trying this with your doctor's advice. This is because these risks are serious too: dolutegravir might for example cause HIV to mutate in a way that makes the virus more difficult to treat, even with drugs that were working beforehand.
Larger studies are already planned or ongoing. Perhaps within a year the long-term outlook for treatment might be different for a significant percentage of HIV-positive people.
The studies all looked at whether HIV antiretroviral treatment (ART) could be simplified from standard 3- 4 drug combinations to using fewer drugs. The studies all used dolutegravir -- the most recently approved HIV drug -- either with one of the earlier HIV drugs called lamivudine (3TC), or using dolutegravir on its own. Three of the studies were in the same oral sessions that will hopefully be webcast.1
Dolutegravir belongs to a class of drugs called integrase inhibitors, which is probably one of the most effective drugs to reduce viral load and also has a low risk of side effects. 3TC is still widely used, and it is also very well tolerated with very few no side effects. Because 3TC came off patent several years ago, generic versions are available very cheaply in all countries.
Treatment with only one or drugs is not a new idea -- but until now results have never been able to matched results using three active drugs. So the current studies were therefore carefully designed to include very close and frequently monitoring, especially for viral load. The people taking part often had complications with HIV drugs that they were already taking due to difficult side effects, lack of available treatment or complicated drug interactions with other important medicines. So there were clinical reasons to consider this experimental approach based on individualised care.
Three studies at EACS 2015 used 50 mg dolutegravir in a two-drug combination with 300 mg lamivudine (3TC). Both drugs were taken together, once-daily, with or without food. On of these studies was in people starting treatment and two were in people switching. Four other studies used 50 mg dolutegravir as a single drug -- i.e., with no other HIV meds.
|Remarkable Results With Dolutegravir Monotherapy|
|Researchers Discuss Questions Surrounding HIV Treatment, Prevention|
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