Fred Schaich of IFARA spoke with Joel Gallant, M.D., of the Southwest Care Center, about new antiretroviral research. Gallant called pre-exposure prophylaxis (PrEP) a "qualified success" and opined, "I really think after this meeting people who continue to bash PrEP will be looked at as kind of the anti-vaxxers of our movement." However, HIV-negative patients are not seen by HIV doctors and primary care doctors often do not know enough about PrEP to prescribe it. One solution may be for clinics that provide HIV testing to discuss PrEP with those whose HIV test comes back negative.
Interesting treatment news included: studies of the new formulation of tenofovir, tenofovir alafenamide (TAF), which showed less renal toxicity than the current tenofovir (TDF, Viread); and the development of single-pill regimens less prone to resistance than those currently available. Today's once-a-day regimens are often not prescribed to the patients with the greatest challenges to adherence because of concerns over the pills' resistance profiles, Gallant said. Single-dose protease inhibitors, as well as abacavir/dolutegravir/lamivudine (Triumeq), are less likely to cause resistance and may be helpful for this population.
Long-acting injectable versions of antiretroviral medications, such as cabotegravir and rilpivirine (Edurant), are also intended for this group of patients. However, people at high risk of non-adherence to conventional drug regimens are also more likely to miss a clinic appointment for the next dose of the drug. These medications may therefore be better suited to settings where patients are already seen regularly, such as prisons or methadone clinics. Injectables may also work well for PrEP, where patients are healthy and treat PrEP like birth control.
Finally, the two combination pills atazanavir/cobicistat (Evotaz) and darunavir/cobicistat (Prezcobix) will likely be recommended when the U.S. HIV treatment guidelines are updated next, Gallant suggested. At the same time, efavirenz (Sustiva, Stocrin) may be "demoted" to an alternative drug, because it does not offer an advantage over newer drugs and can have significant psychiatric side effects. These problems are less pronounced when an equally-effective lower dose of the drug is administered, but, "As long as efavirenz is a brand name drug, we won't see a reduction in dose," Gallant said. However, once efavirenz becomes a generic medication, a 400-mg formulation is possible, he noted.
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The video above has been posted on TheBodyPRO.com with permission from our partners at the International Foundation for Alternative Research in AIDS (IFARA). Visit IFARA's website or YouTube channel to watch more video interviews from the conference, as well as earlier meetings.