News from CROI 2017

The Conference on Retroviruses and Opportunistic Infections (CROI) is one of the most important conferences on HIV treatment and prevention in the world. This year’s conference, held recently in Seattle, heard about new drugs and new ways to treat HIV, as well as the search for a cure, hepatitis C and women’s health.

Most of this edition of HIV update is given over to a round-up of studies from CROI 2017 that are particularly relevant to people living with HIV in the UK.

HIV treatment

• A two-drug regimen of dolutegravir and rilpivirine was able to maintain undetectable viral load for up to 48 weeks in people switching from standard HIV treatment. These are encouraging early results from a phase 3 clinical trial of a treatment simplification strategy. Final results will only be reported 148 weeks after switching. Read more here.

• Bictegravir, a new drug in the integrase inhibitor class reduced HIV viral load as well as dolutegravir (another integrase inhibitor) in a phase 2 clinical trial of people starting HIV treatment for the first time. Future trials will test a single-tablet regimen that includes bictegravir. Read more here.

• Doravirine, a new drug in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class reduced HIV viral load as well as boosted darunavir (a protease inhibitor) in a phase 3 clinical trial of people starting HIV treatment for the first time. Its major advantage over boosted darunavir was its favourable effect on cholesterol and triglycerides. Read more here.

• Two long-acting monoclonal antibodies that prevent HIV from entering human cells may offer new treatment options for people with highly resistant virus and limited treatment options. PRO 140 and ibalizumab work in different ways to conventional HIV treatment. Read more here.

• Immune reconstitution inflammatory syndrome (IRIS) can occur in people who have a low CD4 count when they begin taking integrase inhibitors such as dolutegravir and raltegravir. Because the immune system recovers quickly with these powerful drugs, the paradoxical effect of IRIS is possible. Read more here.

The search for a cure

• A therapeutic vaccine gave exciting results. Thirteen people took the HIV Conserv vaccine, a drug called romidepsin and then stopped taking their conventional HIV treatment. While viral load quickly increased in eight people, the other five people have controlled HIV at very low levels for up to 28 weeks. This has been seen in monkeys before but never in humans. Read more here.

Other health issues

• Making new hepatitis C drugs available to everyone who needs them in the Netherlands has dramatically cut new hepatitis C infections in Dutch gay men. This shows that ‘treatment as prevention’ works for hepatitis C as well as for HIV. In contrast, the NHS generally restricts hepatitis C treatment to people who are already very ill. Read more here.

• Stopping smoking has significant benefits for people living with HIV. Rates of a range of smoking-related cancers fall within a year of giving up, although the risk of lung cancer persists. Also, smoking probably contributes far more to the risk of cardiovascular disease in people with HIV than viral load, antiretroviral drug choice or any factor linked to HIV. Read more here.

• Cervical cancer screening – when screening reveals pre-cancerous cell changes, close monitoring may be preferable to immediate surgical treatment. In three-quarters of women taking HIV treatment, the abnormal cells disappeared or decreased without surgery (which can cause complications for women who would like to have children). Read more here.

• Taking efavirenz with tenofovir and emtricitabine during pregnancy causes fewer stillbirths, pre-term deliveries and other problems than other drug combinations. In previous years, there were concerns about using efavirenz during pregnancy, but a large study shows that women using the most commonly prescribed efavirenz-based regimen had fewer adverse birth outcomes than women using other drugs. Read more here.

What is safe sex now? Does it include undetectable viral load and PrEP?

As part of the Gay & Lesbian Mardi Gras Festival in Sydney last week, an Australian researcher asked whether people’s ideas of what makes up ‘safe sex’ are changing. An undetectable viral load and pre-exposure prophylaxis (PrEP) provide new ways to safely avoid HIV, but research suggests that most people continue to equate safe sex with condom use, and to see not using condoms as ‘unsafe sex’.

Although more and more HIV-negative gay men know about the impact of HIV treatment on infectiousness, many of these men remain unwilling to have sex with HIV-positive men. “Growing awareness of treatment as prevention does not necessarily translate into comfort or confidence in having sex with positive men,” Martin Holt of the University of New South Wales said.

PrEP users sometimes face stigma and sexual rejection too.

He praised a new Australian campaign which presents condoms, PrEP and undetectable viral load alongside each other. No one strategy is presented as superior to the others. Men are encouraged to choose the strategy that is right for them and to respect the choices that other men make.