Benefits, Risks of Dolutegravir Center Stage at AIDS 2018

Heather Boerner

July 17, 2018

AMSTERDAM — The integrase strand transfer inhibitor dolutegravir (Tivicay, GlaxoSmithKline) will be in the spotlight at the upcoming International AIDS Conference 2018.

A session on GEMINI 1 (NCT02831673) and GEMINI 2 (NCT02831764) will explore the two-drug regimen of dolutegravir plus lamivudine (Epivir, ViiV Healthcare) for treatment-naive patients with HIV.

And another session will address the potential association between dolutegravir taken during pregnancy and neural tube defects in infants, which the US Food and Drug Administration recently warned about, as reported by Medscape Medical News.

"The discussion around dolutegravir and conception issues is going to be very real at the conference," said International AIDS Society President Linda-Gail Bekker, MBChB, PhD, from the University of Cape Town in South Africa.

There will also be a forum on the scientific accuracy of the undetectable equals untransmittable (U=U) movement.

More Science and Epidemiology on Treatment as Prevention

Data have shown that effective antiretroviral treatment eliminates the risk for transmission in serodiscordant heterosexual couples (N Engl J Med. 2016;375:830-839) and in gay male couples (JAMA. 2016;316:171-181 and the Opposites Attract study presented at the 2017 AIDS meeting).

However, "transmission risk, which is really the basis of the U=U campaign," has been an "open question," said Jens Lundgren, MD, one of the lead investigators of PARTNER2.

Data from PARTNER2 — a long-term extension of the PARTNER study (JAMA. 2016;316:171-181) — on HIV transmission in gay men will be presented at the conference.

"I think we are bringing data to the floor to clarify the issue," Lundgren explained.

In addition, studies on the scale-up of universal HIV testing and immediate treatment in several countries will examine how treatment as prevention can work as a national policy.

Building on data from a Swaziland study presented last year, as reported by Medscape Medical News, studies out of Botswana, Kenya, Namibia, Switzerland, and Uganda will look at universal access to care and whether a universal test-and-treat strategy can be delivered by both government-managed healthcare systems and public health agencies.

Hard data on the impact of politics on the HIV epidemic will also be presented.

Not Just Healthcare Providers

The conference will start with the Amsterdam Affirmation, a commitment to science-based health policy that has been signed so far by more than 1500 advocates, physicians, and researchers.

The heartbeat of the movement to end HIV is that service providers aren't just clinicians, said Bekker. They are passionate advocates for "their clients' rights, wellbeing, and the best treatment available," she told Medscape Medical News.

The number of presentations on injection-drug use and harm reduction is four times higher than it was last year. And there will be sessions on the effect of the expanded Mexico City Policy on the HIV epidemic in countries with legal abortion, the consequence of sex-worker criminalization laws on access to HIV treatment, and the ongoing impact of discriminatory policies on people with HIV in Eastern Europe and Central Asia.

In addition, a consensus statement from physicians on the science of treatment as prevention and HIV criminalization laws will be featured.

There will also be a focus on younger people, with young researchers and clinicians — to whom Bekker hopes "to hand over the reins" — involved in several studies, and explorations of issues related to specific populations, such as young women at highest risk for HIV.

Bekker and Lundgren have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Heather Boerner @HeatherBoerner

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