January 2018: Volume 11 Number 1
24 January 2018. Related: Editorial.
Welcome to the January 2018 bumper issue of HTB South.
In this annual round-up we include reports on developments in HIV treatment and prevention that will affect low- and middle-income countries (LMICs) – particularly in Southern Africa – both now and in the not-too-distant future.
We have selected articles that mainly focus on ART optimisation, TB, pregnancy and paediatrics.
The big news for global HIV treatment in 2017 was a new pricing agreement, announced in September, that will speed up access to generic, dolutegravir-based fixed dose combinations (FDCs).
This will mean that HIV positive people in generic-accessible LMICs, can be treated at an annual cost per person of around US $75.
The FDCs combine tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) and were developed by Mylan and Aurobindo under licensing agreements from ViiV Healthcare. Both generic manufacturers received tentative approval from the US FDA for TLD in August.
The new DTG-based regimens will help more countries to provide ART to more people and get nearer to 90-90-90 targets.
This year DTG (as well as PrEP) was added to the World Health Organisation (WHO) essential medicines list.
One of the reasons that DTG is an alternative and not a preferred option in WHO guidelines was the lack of data in pregnant women.
So, it was reassuring that reports presented at IAS 2017 on DTG use in pregnancy from Botswana, Europe and the Antiretroviral Pregnancy Registry, did not show an increased risk of adverse outcomes compared with other antiretrovirals.
But more data are needed, particularly with DTG exposure before conception, to reach definitive conclusions – and we expect that to be forthcoming in 2018 and a guideline change is likely.
Good news from Tanzania on breastfeeding was that no HIV exposed infants who were negative at birth, whose mothers started ART before delivery, had suppressed viral loads and exclusively breastfed, were HIV positive after breastfeeding, in a rural cohort.
And more good news was a report from the country with the highest national prevalence in the world, Swaziland, with 32% among a population of just under 1.5 million in 2011, saw a decrease in HIV incidence by almost half and a doubling of viral load suppression among adults.
Developments in paediatric ART included the FDA approval of raltegravir for treatment of neonates from birth to four weeks of age – weighing at least 2 kg. Raltegravir is now one of the few antiretrovirals approved for treating babies from birth.
And (like many groups in 2017), we published i-Base’s refute of controversial BMJ analysis supporting older HIV drugs in pregnancy.
HIV treatment Bulletin (HTB) is available on our website:
As is Fit for Purpose, our twice-yearly review of developments in ART optimisation, and our more detailed review of the HIV treatment pipeline: