'Chipping Away' at Better HIV Outcomes at CROI 2018

Heather Boerner

February 26, 2018

BOSTON — Improved treatment, reduction in long-term complications, and the elimination of disparities in HIV prevention and outcomes will be in the spotlight at the upcoming Conference on Retroviruses and Opportunistic Infections (CROI) 2018.

Although there are unlikely to be any massive data presentations at the meeting, the combined power of numerous smaller trials is expected to make a difference for patients, said Judith Currier, MD, from the University of California, Los Angeles, who is chair of the conference.

"We are really chipping away at things here," Currier told Medscape Medical News. "I don't think you'll see any major game changers at this conference, but you will see improvements in treatment, reductions in long-term complications, an edging toward understanding what it will take for a cure, and improvements in the treatment and prevention of TB."

HOPE, REALITY, and Other Questions

In 2016, CROI delegates got their first glimpse of data on dapivirine administered through a flexible vaginal ring, as reported by Medscape Medical News. This was the second effective prevention medication, after combination emtricitabine and tenofovir (Truvada, Gilead Sciences). At the time, the vaginal ring was found to be moderately effective overall; however, adherence was low among the youngest women especially at risk.

This year, a presentation of data from HOPE, an open-label extension trial, will look at the overall effectiveness of the dapivirine ring and assess whether women are more likely to use it if it has been shown to be effective.

And data from the REALITY trial will begin to address whether the rapid drop in viral load related to integrase inhibitors contributes to immune reconstitution inflammatory syndrome.

"This will really be of interest to people because there have been some observational data about this," said Currier, "but not a lot from randomized controlled trials, including trials with a lot of participants with low T-cells."

Data on the recently approved bictegravir will show how the drug does when patients switch from a combination of dolutegravir, abacavir, plus lamivudine to a combination of bictegravir plus tenofovir alafenamide.

Another presentation will look at potential interactions between long-acting cabotegravir and rilpivirine and the tuberculosis drug rifampin. And data on whether viral suppression can be predicted on the basis of drug levels in hair samples from people starting treatment will also be presented.

In general, the elimination of disparities in HIV prevention and outcomes is a topic of growing concern, Currier explained, and data on the impact of same-day treatment initiation on outcomes will be presented at the meeting.

"CROI has grown a lot in terms of conversations on implementation science," she pointed out.

But Currier said what she hopes most is that this conference will focus on the power and needs of the younger generation — both of researchers and activists. A dance performance by a group of young people with kick off opening night.

An 'Imperative' Focus on Women

The emphasis on women will go beyond data on cardiovascular diseases more common in women, such as peripheral artery disease, the vaginal microbiome, HIV transmission in the breast milk of women on suppressive treatment, and information on HIV prevention that women want. This year, for the first time, large datasets presented at CROI are required to show the number of female participants they include and whether results varied by sex.

The move is a response to concerns raised in previous years, said Sharon Hillier, PhD, from the University of Pittsburgh, who is vice chair of CROI. In the past, such delineation has been encouraged but not required.

What's more, the Martin Delaney Presentation for new investigators is dedicated specifically to women in research. The idea is to strengthen the mentorship pipeline and help women develop careers in research.

"After years at CROI, we think this is not just a good idea, it's imperative," said Hillier. "Women need to be at the table, not just as participants, but also as researchers, decision makers, and leaders in the communities."

Future conferences will include readouts of major studies, including those of broadly neutralizing antibodies, and current preclinical data on topics such as a once-weekly HIV pill. But for now, Currier said she believes the data at this year's CROI make a strong case for continued funding.

"We are in this for the long haul," she added. "The investments we make in research, they really do pay off."

Currier and Hillier have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Heather Boerner @HeatherBoerner

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