HTB: no. 1 – plus HIV and COVID-19 (22 January 2021)

This first issue of HTB for 2021 includes latest reports on both HIV and COVID-19.

In this issue, HIV news includes approval of long-acting injectable ART in the EU and the US. US pricing is complicated – and this is set at just under $50,000 a year for the combination. Access and use in the UK will depend which of the current combinations it is pegged to – and in many EU countries too. Fostemsavir was also importantly just approved in the EU to treat MDR HIV, but the limited expected demand means approval in the UK will be able to sidestep NICE.

UK news also includes reports from PHE about the increase in LGV among gay men and the impact of COVID-19 on rates of HIV and STIs.

And the South African ADVANCE study, used to provide data on dolutegravir use globally, also reports unexpected results linked to baseline drug resistance.

The last month also brought the most important news about vaccines against COVID-19 as three are now approved in the UK, and other are still in studies. And hopefully, as coverage is extended, this COVID section of HTB can steadily become smaller. But not for this issue…

Consensus is now growing – supported by BHIVA and EACS – that HIV might be associated with an increased risk of serious outcomes, based on several recent, large, well-powered studies. Even though none of these studies is perfect, they can justify HIV being included as a priority group in national vaccination programmes. In the UK this will routinely be priority group 6 (out of 9) but in complex cases this can be higher (group 4). For their most at-risk patients, HIV doctors are likely to need to work with GPs.

We report that the Pfizer vaccine might retain sensitivity to recent SARS-CoV-2 variants – as least as we go to press. But by next week, more sophisticated analyses could easily become more informed.

And the news on treatment – covered in seven reports – includes more positive results than negative ones. At we went to press, a large phase 3 RCT reported that oral colchicine – a cheap anti-inflammaotry – reduced hospitalisations and deaths in outpatients. There is other positive news for IL-6 agonists tocilizumab and sarilumab, and two different dual combinations of monoclonal antibodies: one from Eli Lilly and one from Regeneron. Plus a small study tentatively reporting benefits from IV methylprednisolone in hospitlaised adults.

As a caution, negative results are reported for a monotherpy antibody, and azithromycin had zero benefit in the UK RECOVERY study -which many people expected. Also confirming no role for hydroxychloroquine and lopinavir/r, new WHO guidelines recommend that neither drugs has any benefit in any stage of infection, including within research.

We include several reports related to Long COVID – increasingly important – including recent NICE guidelines. Plus we report on other updated guidelines covering treatment and vaccines.

Last year was difficult and problems will continue long into 2021. So again, we hope all readers will be careful to reduce risks to yourselves and to others, and we continue to thank and appreciate the dedication of all who work to keep the rest of us safe.

Finally, if you have read this far, please could to take a minute for feedback. Is this expanded coverage of COVID in HTB still useful?

Even a yes/no answer will help us shape i-Base services for the upcoming year.

Thank you

Finally, with all the best plans to be out a week earlier, the pace and importance of breaking news delayed this final compilation.

Some of the reports in this issue were posted online in late December with new articles added every day since. For example, advance articles for the next issue are already posted, and there will shortly be news from the R4P conference.