IAS 2019
A novel pharmacological mechanism of action, the use of dual therapies that can replace the usual antiretroviral regimens, and changes in administration guidelines that allow spacing out treatment are some of the advances being investigated in the approach to HIV/AIDS.
Editorial Staff, July 26, 2019
Regarding research on dual therapy, two studies presented in Mexico have demonstrated the safety and efficacy of dolutegravir plus lamivudine, both in patients starting treatment for the first time and in those switching after viral suppression on another regimen. The first analysis provided data from two identically designed clinical trials with 1,400 patients (the GEMINI 1 and 2 studies, coordinated by Pedro Cahn of the Department of Infectious Diseases at the University of Buenos Aires, Argentina). These randomized, phase III trials compared the safety and efficacy of this dual therapy in treatment-naive patients versus those who received the three-drug combination: dolutegravir, tenofovir, and emtricitabine.
After collecting data over 96 weeks, it was found that the two-drug regimen is no less effective than the three-drug regimen over this two-year period.
The second study (TANGO) is another randomized phase III trial comparing the safety and efficacy of switching from dolutegravir, tenofovir, and emtricitabine therapy to dolutegravir and lamivudine therapy. This analysis included 741 participants, randomly assigned to the two regimens. It found that, after 24 weeks of therapy, the two-drug regimen was not superior in achieving and maintaining viral suppression. While the study will continue for 148 weeks, this initial study suggests that switching to dual therapy could be an option for those currently on triple therapy.
A new drug for treatment and PrEP
At the IAS meeting, promising data were also presented on MK-8591, the first drug in a new class of treatments known as nucleoside transcriptase translocation inhibitors. The data came from a 48-week, phase IIb trial in 121 patients in which MK-8591 was used as part of first-line therapy.
This new drug has also been studied as a potential implantable pre-exposure prophylaxis (PrEP) formulation. The phase I study evaluated the drug against a placebo, yielding preliminary but promising data regarding tolerability and safety, which suggest evaluating the preventive treatment for at least one year.
Maintenance strategy every two days
Seeking to reduce the number of pills a person living with HIV needs to take, another randomized phase III study compared the use of three-drug regimens taken four days a week with the daily regimen.
The study was conducted in France, led by Pierre de Truchis of Raymond Poincaré Hospital and Roland Landman of Paris Diderot University. It included more than 600 patients randomly assigned to the two approaches. After 48 weeks of treatment, the four-day-a-week regimen was found to be non-inferior to daily treatment in maintaining viral suppression. These findings provide further evidence that new antiretrovirals can be used in innovative ways.
From: https://www.diariomedico.com/especialidades/vih-y-hepatitis/nuevos-regimenes-terapeuticos-podrian-cambiar-el-abordaje-del-vih.html