What happens when HIV is treated extremely early after HIV acquisition? A man on PrEP was diagnosed with an HIV RNA of 220, 4th generation Ag/Ab negative, around 10 days after acquiring HIV. He was treated for 34 months with combination ART, which led to numerous negative reservoir assays, then stopped treatment -- only to experience virologic rebound (same as original infecting virus) 225 days later. In summary, reservoir and viral diversity were reduced -- but virus not eradicated.
Weekly MK-8591 effective in animal model of PrEP. The drug, a "nucleoside reverse transcriptase translocation inhibitor" with a mechanism of action somewhat different from current NRTIs, is highly potent with a long half life. Study used rhesus macaques and SIV; none became infected after SIV challenge that infected untreated controls.
Doravirine/TDF/3TC non-inferior to EFV/TDF/FTC. 84% vs 81% < 50 at week 48. DOR with significantly fewer CNS side effects, better lipids. 1.6% of DOR vs 3.3% of EFV subjects with resistance. Results of this and prior phase 3 DOR study suggest this NNRTI has the best efficacy, safety, and tolerability profile in this drug class.
3TC was non-inferior to TDF/3TC when given with fixed-dose DRV/r. With the caveat that this is an interim analysis of a fully powered study, and used a 400 copy/mL threshold, the results are encouraging -- and DRV/r + 3TC is a much more attractive regimen than the LPV/r + 3TC regimen used in GARDEL. Note the use of a non-FDA approved DRV/r coformulation (study done in Argentina). In the USA, this would presumably be DRV/c, can we extrapolate?
With 2 NRTIs, DTG superior to LPV/r as 2nd-line therapy after failure of a 2-NRTI/NNRTI-based regimen. The results so favored the DTG strategy that the study's Independent Data Monitoring Committee stopped the LPV/r arm (all subjects are now receiving DTG). Findings should have a huge impact on clinical practice -- will DTG (not boosted PI) based regimens now be the standard of care for second-line therapy? Can we extrapolate to those currently virologically suppressed on boosted PIs + NRTIs due to NRTI resistance?
What a weird conference center. Numerous escalators, winding hallways, and a disorienting layout made getting around tricky. At least the session halls for the slide sessions were very comfortable (though some over-crowded).
Why can't we have a subway system like that? The Paris Metro seems to get better all the time -- fast, clean, reliable, inexpensive. I'm sure it's not perfect, but is there a better urban rapid transit system in a large city anywhere else?
This article was provided by NEJM Journal Watch. It is a part of the publication The 9th Conference on Retroviruses and Opportunistic Infections. NEJM Journal Watch is a publication of the Massachusetts Medical Society.
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