Title

State of the ART

Code

WESY07

Session Type

Symposia Session

Venue

Hall 12

Date Time

Wednesday 25 July, 16:30 - 18:00

Co-Chairs:

Serge Eholie, University Teaching Hospital, Abidjan, Cote D'Ivoire
Jenny Hoy, The Alfred Hospital and Monash University, Australia

This session will discuss the latest findings on ART, including treatment across the human lifespan (from newborns to elderly) and in special populations (including men who have sex with men, transgender, injection drug users, sex workers and migrants). It will consider: ART strategies for treatment and monitoring; new and investigational antiretroviral agents; ART-related adverse events, side effects and toxicities; adherence; and drug resistance.

16:30 WESY0701	Introduction

16:34 WESY0702	ART in Pregnancy Lynda Stranix, University of Zimbabwe, Zimbabwe	Slides

16:52 WESY0703	Sequencing strategies in resource-limited countries Leticia M Perez-Saleme, Hospital de Especialidades Centro Medico Nacional siglo XXI, Mexico	Slides

17:10 WESY0704	New drug delivery systems Kimberly Scarsi, College of Pharmacy, United States	Slides

17:28 WESY0705	New antiretrovirals Hans-Jürgen Stellbrink, University of Hamburg, Germany

17:46 WESY0706	Lange/Van Tongeren Prizes (IAS/ANRS) for Young Investigators: Annual prizes Pr François Dabis, Director, ANRS, France Michiel Heidenrijk, Joep Lange Institute, Netherlands Brenda E. Crabtree Ramírez, ational Institute of Health Sciences and Nutrition, Salvador Zubirán (INCMNSZ), Mexico

17:56 WESY0707	Closing remarks

AUTHOR

Sean Wasserman

SUMMARY

This session summarized recent evidence and highlighted areas of uncertainty around the optimal use of currently available ART in pregnancy and resource-limited settings. Novel ART delivery systems and the state of ART drug development were also discussed.

HIGHLIGHTS

Access to lifelong ART is variable across and within regions, and there are challenges in retention in care. There is a paucity of data relating to the efficacy and safety of ART in pregnancy. Priorities for future research include generating pharmacokinetic data and pharmacovigilance in this population. Leticia Perez-Saleme summarized recent studies evaluating second-line ART regimens in resource-limited settings, with a focus on the role of background NRTI regimens. She used data from the EARNEST and DAWNING trials to show that routine resistance testing may not be required in resource-limited settings. Kimberly Scarsi summarized various approaches for novel ART drug delivery systems. She showed data from the LATTE2 study, where long-acting nanoformulated cabotegravir and rilpivirine injectables had trough concentrations comparable to oral dosing which remained above the IC90. Hans-Jürgen Stellbrink summarized new agents in development with novel mechanisms of action, including neutralizing antibodies and anti-CD4 antibodies (“biologicals”).

CRITICAL ASSESSMENT

Nanomedicine applications for HIV therapy include supporting dose reduction, targeting sanctuary sites, and combining with long-acting systems for dose simplification. Although parenteral cabotegravir and rilpivirine are effective and have high patient acceptability, there are multiple challenges around their implementation. There are important reasons to develop new ARVs, including use in salvage regimens, as accompanying drugs to reduce risk of resistance, providing switch options, and to cover coinfections such as hepatitis B. Although there are a number of candidate molecules in early development, there are few options without cross resistance to existing classes, and there are challenges around manufacturing biologicals.