Treatment & related issues Highlights from AIDS 2012 (and 14th International Workshops on Co-morbidities and Adverse Drug Reactions in HIV, July 2012)

Sean R Hosein

Topics

• Selected new drugs and up coming all in one

pills or co-formulations

• Cancer risk issues

• The return of Aspirin

But first…a look inside

A look at the immune system

Cells of the immune system

Another way to look at immunity

Inside the infected cell – a virus factory

Several targets need to be hit

Stribild (the quad)

Stribild – 3 anti-HIV drugs in one pill

• tenofovir + FTC (Truvada)

• Elvitegravir (new)

• Cobicistat (new)

Stribild – 3 anti-HIV drugs in one pill

• tenofovir + FTC (Truvada)

• Elvitegravir (new)

• Cobicistat (new), similar but yet different to ritonavir (Norvir)

Stribild – 3 anti-HIV drugs in one pill

• Taken once daily with food

• For people who are taking treatment for the first time

• Generally safe and effective compared to other commonly used HIV regimens

• Not for people who have kidney dysfunction

Stribild – the first of many

• darunavir (Prezista) – darunavir + cobicistat + Truvada = “Daruna-quad”

• Atazanavir (Reyataz) – atazanavir + cobicistat + Truvada – “Ata-quad”

• These are further behind in development

Inside the infected cell – a virus factory

Experimental integrase inhibitor - dolutegravir

• Tiny pill

• Taken once daily

• May be used against some strains of HIV resistant to other integrase inhibitors

Experimental integrase inhibitor - dolutegravir

• Dolutegravir being tested in different populations

• Will be put into one pill with these medicines: 3TC + abacavir (Kivexa)

• Long acting dolutegravir formulations being developed – oral and injectable

• Future dosing – once monthly, once every six months?

Other issues…

• HIV …

• Depression

• Hepatitis C

• Abnormal cholesterol

• High blood pressure

• Diabetes

• Cancer

Access issues

Cancer risk

• ART does not completely restore the immune system – HIV-related inflammation continues

• Co-infections: herpes viruses, hepatitis B and C viruses, HPV (human papilloma virus)…

• Substance use

• Other factors

Thinking about inflammation

Reducing cancer risk

• Getting help for substance use

• Exercise – can start with short walks

• Vaccinations – talk to your doctor or nurse; hepatitis A and B; HPV

HIV causes excessive inflammation

• Effective HIV therapy reduces inflammation

• But some signals of inflammation continue

• Over the long-term, this may affect different organ-systems, particularly the heart and blood vessels

HIV & inflammation

HIV & inflammation

• In the early 1990s when effective therapy didn’t exist

• Aspirin to reduce inflammation

• Didn’t work

HIV & inflammation

• In a small and short clinical trial, low-dose Aspirin (81 mg per day)

• Aspirin reduced production of inflammatory substances

HIV and inflammation

• Larger, longer study needed to assess potential benefit and risk (bleeding)

• Watch for more studies about this cheap and simple drug

• Aspirin should always be taken under medical supervision because of risk of bleeding

• In the meantime, talk to your doctor

Details

• About Stribild (the quad) – TreatmentUpdate 191, 192:

• www.catie.ca/en/treatmentupdate

• About dolutegravir, Aspirin, HIV-related inflammation: TreatmentUpdate 193

• French link: www.catie.ca/fr/traitementsida

Details – HIV-related cancers

• CATIE News:

www.catie.ca/en/catienews

www.catie.ca/fr/nouvellescatie

Acknowledgements

Tim Rogers

Michael Bailey

For more information visit www.catie.ca

Fin