What Will HIV Treatment Look Like in 5 Years?

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HIV antiretroviral therapy first arrived on the scene almost 30 years ago and changed HIV from being a fatal virus into a chronic, manageable disease. Since then, the medications have become more effective, simplified and tolerable. However, adherence and side effects still remain an issue. Today, there's buzz and research surrounding longer-acting regimens, less frequent doses and even possible cure strategies.

We asked some of the leading experts and advocates in HIV care what they think HIV treatment will look like in five years. These interviews were conducted at the 21st Conference on Retroviruses and Opportunistic Infections in Boston earlier this month.

Reporting for this slide show was provided by Terri Wilder and Myles Helfand.

Cost vs. Benefit Decisions

"I think we are due for a collision between the economics of how do we save money versus what we've been doing, which is the best possible therapy for the patient.

"Our field continues to improve. There are exciting developments. There's improvements in things that are already pretty good, and making them even better. We still see new drugs. We still see coformulation.We also know that there are already, and still to come, generics of the existing drugs -- which have been really good, but not as good, based on the studies we see.

"So I think the really interesting question will be, do we, as clinicians, get to do what we're trained to do, which is to provide the best possible regimen, regardless of what it costs? Or are we forced to do just OK because a payer says, 'We're not paying for the best'?"

-- Calvin Cohen, M.D., M.S., Director of Research, Community Research Initiative of New England, Boston.

Better Care and Long-Term Success

"It depends on whether you're asking me about how we should treat HIV, or what the health care system will look like. But I do think that in the next five years we're going to be talking a lot more about how we get people to be successful on therapy over decades, instead of over three to five years that we've been doing for so, so long.

"I also think that there's going to be some really exciting breakthroughs for us in the next five years. I think that we're a lot closer to understanding targets and mechanisms that will lead us along the right path for a cure."

-- Dawn Averitt, The Well Project.

Simplified Second-Line Treatment

"I think first-line therapy is going to look very similar to what it looks like now. I think second-line therapy is going to be very dramatically changed. I think it will be simplified and I hope we're in the situation where we have a single tablet."

-- Francois Venter, Associate Professor of Medicine, University of the Witwatersrand, and Board Member, HIV Clinicians Society.

Longer-Acting Regimens and New Drugs to Treat Persistence

"I think that we're going to be moving to longer-acting agents. We're going to move to agents that can be injected or given through different routes. So I think that is going to be the new landscape.Also, I think we're looking at new compounds that are going to be available for our patients that have hard-to-treat HIV."

-- Antonio Urbina, M.D., Associate Medical Director, Spencer Cox Center for Health, St. Luke's-Roosevelt Hospital, New York.

Greater Reach and Less Frequent Doses

"I think the future HIV landscape will be marked by two changes from what we see now. The first will be a much greater effort and infrastructure to engage the unengaged. Since the cascade shows that in any given community 50 to 70 percent of the people are not suppressed, if we don't migrate toward getting those people in care it's not going to change the trajectory of the epidemic. Whether that will involve different strategies about doing care, such as less frequent injections of medicine or simpler regimens that get rolled out by different levels of providers, and how that will be influenced by the Affordable Care Act and 'Obamacare,' that will be an emerging question."

-- Richard Elion, Director of Clinical Research, Whitman Walker Health.

More of the Same

"For the populations that I'm particularly interested in, people with very little money in lower-middle income countries, I'm fearful that the landscape is going to look very similar to how it does now, because I don't think that we're progressing fast enough -- and often for reasons that are not to do with science or medicine, like regulatory issues, pricing, or having not done the right piece of research as the drug was being developed to enable it to be used in people like women. So I think it's going to look much the same."

-- Polly Clayden, Treatment Activist, HIV i-Base, London, U.K.

For More Information

To explore the issues raised by these HIV care providers, researchers and advocates in more depth, check out the following resources on TheBodyPRO.com:

  • HIV Care Today, a multi-author blog in which care providers discuss the everyday challenges of their jobs, recent developments in their fields and issues relevant to the evolution of HIV/AIDS care.
  • HIV Management in Depth, an interview series in which top experts go in depth to discuss critical issues in HIV clinical management.