November 6, 2015
This week we read about the FDA approval of Genvoya, a new single-tablet HIV regimen containing tenofovir alafenamide (TAF). We also read very promising early results on a long-acting injectable regimen containing cabotegravir. Plus, the International Association of Providers of AIDS Care (IAPAC) releases new guidelines for optimizing the HIV care continuum.
To beat HIV, you have to follow the science!
E/C/F/TAF is a single-tablet combination regimen, the first FDA-approved regimen to contain tenofovir alafenamide (TAF), a drug of tenofovir that has been shown to be more potent at lower doses and gentler on the bones and kidneys.
E/C/F/TAF is approved for treatment-naive patients, as well as adults with undetectable viral loads on other regimens, according to the FDA press release. Additionally, E/C/F/TAF is not recommended for patients with severe kidney disease, but can be taken by those with moderate kidney disease.
Early 32-week results of the LATTE-2 study supported a long-acting injectable regimen of cabotegravir plus rilpivirine (Edurant), according to data presented at the 15th European AIDS Conference (EACS 2015). Cabotegravir is an investigational integrase inhibitor currently being studied as an oral pill and long-acting injectable.
The study followed 309 HIV-positive individuals who all achieved undetectable viral loads on a regimen of once-daily oral cabotegravir plus two nucleoside reverse transcriptase inhibitors. The participants were then randomized into three groups:: one to continue the oral regimen, and two to receive a long-acting injectable regimen of cabotegravir plus rilpivirine, either once every 4 weeks or once every 8 weeks.
After 32 weeks, study participants maintained undetectable viral loads at similar rates in all three groups -- 95% in the 8-week group, 94% in the 4-week group, and 91% for those who stayed on the oral regimen, according to the study press release. Patients receiving injections once every 4 weeks reported more adverse events leading to withdrawal (5%) compared with those receiving injections once every 8 weeks (2%) and those on the oral regimen (2%). The most common adverse event was injection site pain, reported in 93% of participants receiving injections.
The International Association of Providers of AIDS Care (IAPAC) released guidelines for optimizing the HIV care continuum. In total, there are 36 recommendations, broken down into six sections, including:
One of the notable recommendations is, "For high-risk individuals who test HIV negative, offering PrEP [pre-exposure prophylaxis] is recommended in addition to the provision of free condoms, education about risk reduction strategies, PEP [post-exposure prophylaxis], and voluntary medical male circumcision."
Also notable is the increased focus on retention in care, including recommendatins for routine treatment adherence monitoring, and patient education and support for medication adherence and keeping clinic appointments.
Quality of HIV care was lower among low-volume providers (those who treated fewer than 20 patients living with HIV) compared with experienced HIV clinicians, according to a New York state study published in Clinical Infectious Diseases.
For patients of low-volume providers, viral load suppression rates were 56%, compared to 77% of HIV specialists' patients, according to a report by Aidsmap. Low-volume providers were also less likely to give regular viral load tests than HIV specialists (44% vs. 90%), as well as regular CD4 tests (21% vs. 90%).
Additionally, low-volume providers were less likely than HIV specialists to offer syphilis screening (32% vs. 80%) and screening for mental health issues (28% vs. 48%), according to Aidsmap.
"Access to experienced providers as defined by patient volume is an important determinant of delivering high-quality care and should guide HIV workforce policy decisions," the study authors concluded.
Is there a development this week in HIV research that you think we missed? Send us a tip!
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
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