March/April 2016: Volume 17 Number 3/4

This edition of HTB mainly features our first reports from the 23rd Conference on Retroviruses and Opportunistic Infections (CROI 2016), which took place in Boston.

Research into new drugs included long-acting/extended release formulations with the potential for much longer dosing intervals than the current oral antiretrovirals, some of which might be useful as both treatment and PrEP.

Promising 32-week results were presented from the LATTE-2 study of dual long-acting injections of cabotegravir plus rilpivirine. And – one of the conference surprises – the first virological data from a new investigational NRTI, MK-8591 that has the potential for weekly oral dosing or even annual injections.

PrEP was a focus throughout the conference. We report the dramatic increase in use of oral TDF/FTC for PrEP in the US (with a few cautions), the first data on TAF, the possible roles for maraviroc and cabotegravir and only limited protection from the dapivirine vaginal ring. We also look to future formulations: “pills, films, gels, injections and depots”.

Dolutegravir remains an important potential option for all countries and we report promising 48-week results in children, early data in pregnancy, and that similar viral load reductions were seen at week 4 when dolutegravir was used with 2- or 3-drug initial ART.

We also report that global uptake of generic versions of this drug in low- and middle-income countries, together with TAF and reduced dose efavirenz could mean savings of up to US $3 billion by 2025.

Other news includes a positive opinion on dual formulation of F/TAF adopted by the EU and new TAF-containing fixed dose combination (with FTC and rilpivirine) approved in the US.

Treatment access includes community opposition to dolutegravir and cabotegravir patents in India; transgender people are being left behind in the fight against HIV and South Africa’s Mbeki still shows no remorse for his role in AIDS deaths.

Returning to PrEP, now established as a cornestone to global programmes to reduce HIV incidence in the highest risk groups, we contrast approval in Canada with the decision by NHS England to not only block access to PrEP but to block even public discussion about PrEP.

This decision will help ensure at least 500 people continue to test HIV positive each month and that incidence rates next year will likely remain above 6000.

This is a sexual health crisis for those who are most vulnerable, especially those from the gay and trans communities.