HIV i-Base

CROI 2016 – first reports: PrEP, new HIV drugs, cure and access

Simon Collins, HIV i-Base 

CROI logo2 no key

Early reports from CROI

Introduction

Every few years, the annual Conference on Retroviruses and Opportunistic Infections (CROI) returns to Boston for one of the most important scientific HIV meetings.

With over 1000 studies presented, there is far more to report than the key studies that make headline news.

A few selections below are likely to highlights to expect in 2016.

The programme is already posted to the conference website.
http://www.croiconference.org/electronic-materials

Although the programme is now online, abstracts are not publically available until after the conference ends. Webcasts are made available on the day after oral presentations and PDF files for posters are available after the meeting.
http://www.croiconference.org

This year, major studies will present research on basic and clinical science relating to prevention, treatment and access.

Overview of CROI 2016

PrEP: tenofovir/FTC

Dozens of studies will report on current oral PrEP: access programmes, monitoring, additional safety data and a few studies with cautions (mainly STIs and side effects but also the risk of infection with drug resistant HIV).

The big picture however, will be the success of this new intervention that is steadily transforming life for at least 40,000 people currently using PrEP in the US and increasing numbers globally.

PrEP: new drugs and formulations

Just as PrEP is gaining wider recognition as a word for the pill that prevents HIV transmission, CROI 2016 will complicate this with a range of other drugs, compounds and formulations that might become future PrEP.

  • Other oral drugs that might be used for PrEP (TAF, maraviroc and MK-8591).
  • Long-acting injections (cabotegravir LA plus rilpivirine LA).
  • Rectal and vaginal gels (tenofovir, PC-1005 and MK-8591).
  • A vaginal ring (daprivirine) with efficacy results from phase 3 studies.

New antiretroviral treatment

Even with current treatment that is highly effective and generally well tolerated, there is still a pipeline of new drugs.

CROI 2016 will include new clinical results on many new drugs.

  • Dolutegravir results during pregnancy and in younger children (aged 6 to 12 years) – essential for global recommendations.
  • Long-acting injections of cabotegravir plus rilpivirine, including tolerability of these injections – results from LATTE-2 study.
  • Tenofovir alafenamide (TAF) – the new version of tenofovir: switching studies, longer term renal and bone safety and drug resistance.
  • BMS compounds (now transferred to ViiV) that include a maturation inhibitor (BMS-955176), an attachment inhibitor (BMS-663068) and first data on a new compound with multiple sites of action (BMS-986197).
  • Doravirine (an NNRTI) and MK-8591 (an NRTI), both from Merck.
  • Frist clinical data on ABX464 – a new compound that might allow less than daily dosing.

ART strategies

  • Plenty of studies about earlier treatment in various settings, including six studies from the START study and results from the POPART study.
  • Immune responses in early infection and the CD4:CD8 ratio.
  • Other approaches to treatment – including the monoclonal antibody VRC01, anti-PD-1, genetic therapy and stem cell research – all over-lapping with strategies to cure HIV.

HIV complications

Numerous studies and session with cover complications of HIV and/or ART.

  • HIV and the brain – including neuroimaging.
  • Bone health and treatment: overviews and links to specific drugs.
  • Liver health, with and without hepatitis.
  • Hepatitis C will have dozens of studies, including a late-breaker using only six weeks of treatment with new oral drugs for HIV positive people – likely to be gay men – whose HCV is treated in acute infection.
  • HIV and the gut – and role of microbia.
  • HIV and the heart – including lipodystropy and other side effects.

Cure research

  • Measuring and activating viral reservoirs – a key step in current approaches to cure research. Incudes vacc-4x/Gm-CSF and romidepsin.
  • Studies using the monoclonal antibody VRC01.
  • Updates on gen therapy with SB-728.
  • Intriguing results of animal studies using TLR-7.

Global access

Global access now features strongly every year including plenary and other oral presentations that will be webcast.

Updates on practical issues related to achieving 90:90:90 goals in different settings. This the UNAIDS target for getting 90% of people diagnosed, 90% of those on ART, and 90% of those with undetectable viral load.

Each stage is easier or more difficult in each setting. Even if this target is reached, only 72% of HIV positive people will have an undetectable viral load overall – showing the importance of aiming for higher.

Early reports from CROI: prepress articles for the next issues of HIV Treatment Bulletin (HTB) and HTB South.