Volume 14 Number 3/4 March/April 2013

As with every year, CROI 2013 had so much to report that this will be spread over two issues of HTB.

This year’s big story in mainstream media – picked up by reporters worldwide (and provoking some sensationalist journalism) – was the news of a functional cure in an HIV infected infant. We include Richard Jefferys’ elegant analysis of this case report. We hope that the attention this child has been given will lead to further steps in cure research as well as improvements in the implementation of maternal/ infant programmes where transmission is a risk.

Developments in pipeline drugs were presented at the conference, including for dolutegravir and tenofovir alafenamide (TAF, GS-7340), which might offer improved antiretroviral options in the not to distant future. With low milligram doses both also have the potential for low cost. MK-1439 and cenicriviroc are covered, as well as long-acting formulations of rilpivirine, GSK-744 and novel nanoformulations. Important data for GSK-744 showed two intramuscular doses, a month apart, protected rhesus macaques after repeat HIV exposure compared to placebo. Monthly injections have the potential to overcome the adherence obstacles associated with oral PrEP, seen in the VOICE trial, also reported in this issue.

Functionally cured infant aside, there was an abundance of other paediatric data. The completed ARROW trial, conducted in Uganda and Zimbabwe, in collaboration with the UK MRC has produced a rich set of data to help guide children’s treatment, particularly in resource limited settings. The development of lopinavir/ritonavir for infants and young children continues and other presentations add to what we know about new and older antiretrovirals for children.

The conference had a generous focus on TB. Nathan Geffen covers the much-anticipated RIFAQUIN trial of moxifloxacin and rifapentine. This regimen is notably taken only once a week in the continuation phase compared to the daily dosing required for standard of care. Also for TB was a study showing that combining two tests improves diagnostic sensibility.

And a study on cryptococcal meningitis showed deferring ART by six weeks reduces mortality compared to immediate treatment – in contrast to TB and most other opportunistic infections.

Other non-CROI news includes a positive EU opinion for Stribild (an FDC formerly known as Quad), a detailed look at the question “When to start?”, the updated US guidelines (starting earlier) and an increase in the sample size of the START trial (that will finally answer this critical question).

HTB supplements

Two of the i-Base treatment guide have been updated and are included as supplements to this issue of HTB.

Both are already online and are available free, including in bulk to UK clinics. Please order online in the regular way.

Links to other websites are current at date of posting but not maintained.