Treating Resistant HIV, Patient-Centered Care at HIV Glasgow

Heather Boerner

October 22, 2018

GLASGOW — People whose HIV cannot be suppressed with current treatments will be in the spotlight here at HIV Drug Therapy 2018.

These patients are the exception, but they are out there, said Andrew Philips, PhD, from University College London.

Fortunately, he added, there are new studies being done for "people who have zero active drugs" available to them, some of which will be presented at the conference.

Among those will be long-term data from the phase 3 BRIGHTE trial (NCT02362503) of the entry inhibitor fostemsavir (ViiV Healthcare); data on MK-8591 (Merck & Co), the investigational agent that targets nucleoside reverse transcriptase inhibitor NRTI)-resistant viruses; and findings from a phase 3 study of the post-attachment inhibitor ibalizumab (Trogarzo) for people with multidrug-resistant HIV.

Dual Therapy

Dual-therapy research will likely take center stage at the conference, said Carlos del Rio, MD, from Emory University in Atlanta

There will be a meta-analysis of ritonavir-boosted protease inhibitor therapy with either lamivudine or tenofovir, and additional data from LATTE-2, which is testing cabotegravir and rilpivirine in people with HIV, he reported.

Follow-up data from the SWORD-1 and SWORD-2 trials on viral suppression with dolutegravir and rilpivirine dual therapy will also be presented.

And data on the safety of elvitegravir and bictegravir in pregnant women, to be presented by representatives of Gilead, will be of particular interest in light of the signal for increased neural tube defects seen in women taking dolutegravir at conception, as reported in Medscape Medical News.

Sessions that address the challenges faced by physicians every day, including one on polypharmacy in people with HIV, are not flashy but are essential "in order to not do any harm in choosing drugs," said Lene Ryom, MD, PhD, from the University of Copenhagen.

With people taking more and more different drugs, it is important to understand how they interact, she explained. "Some we know well and may be able to minimize, but others we are perhaps not as clear about."

Teaching Through Stories

Throughout the conference, world experts on pre-exposure prophylaxis, treatment failure, drug–drug interactions, and HIV treatment and prevention in women, among others topics, will lead discussions on best practices for patients in all kinds of situations.

del Rio — a member of the International Antiviral Society–USA, which is collaborating with the Glasgow conference and other organizations, such as the International AIDS Society, the British HIV Association, and the European AIDS Clinical Society — will moderate a panel on "challenging cases."

This conference is "sort of like the European CROI, in that all the European researchers come together" to discuss science and treatment issues in their areas, del Rio told Medscape Medical News.

Ryom said she is looking forward to the sessions in which people living with HIV tell their own stories. A session organized by the International AIDS Society will feature a young adult living with HIV. And Ryom herself will moderate a panel on people living with HIV over the long term, such as people who were born with the virus and people growing old with HIV.

This inclusion of patients in research and practice discussions is a shift that has been evident at other conferences, she said.

We need to meet patients "where they're at," said Ryom. "As clinicians, we obviously have an agenda when we see patients. We have certain things we want to get sorted. But my agenda is not always the same as the patient's agenda. Getting to what's important for them is important from a clinical perspective, so they leave the consult feeling that they have help with whatever they're dealing with."

Phillips reports receiving speaking fees from Gilead . del Rio has consulted for ViiV Healthcare and InnaVirVax. Ryom has disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Heather Boerner @HeatherBoerner



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