Released: July 16, 2019
By Anton L. Pozniak, MD, FRCP, IAS President
The biannual conference presented by the International AIDS Society (IAS) is one of the leading scientific conferences in the HIV field. In total, the upcoming IAS 2019 meeting in Mexico City, Mexico, will feature more than 1100 accepted abstracts, with as many as 6000 delegates expected to attend. This should be an exciting event for all participants and an important global convening of the HIV scientific community. Among the many topics that will be covered, here is my take on key new data that will be presented.
Novel ARVs IAS 2019 will include the Week 96 safety and efficacy data from the phase III BRIGHTE study, which is investigating the novel HIV-1 attachment inhibitor prodrug fostemsavir in heavily treatment–experienced participants living with multidrug resistant HIV. These long-term outcomes data will be crucial to our understanding of how to treat this population. In addition, we have been awaiting data on MK-8591, a long-acting nucleoside reverse transcriptase translocation inhibitor, and we will see the 48-week data on its tolerability, safety, and efficacy when combined with doravirine and lamivudine (3TC) in treatment-naive adults. Finally, GS-6207, a first-in-class, long-acting, HIV capsid inhibitor, is also a new drug of interest. The safety and antiviral activity data over 10 days following a single SC dose of GS-6207 in people living with HIV will be presented.
ARV Trials There will be several interesting studies presented on first-line ART. The durability and long-term efficacy of 2 drug dolutegravir (DTG)-based regimens are important, as these are now being prescribed for ARV-naive people. The Week 96 results from the GEMINI studies of DTG plus 3TC in ARV-naive adults will provide this important information.
In addition, are there advantages with using tenofovir alafenamide (TAF) over tenofovir disoproxil fumarate (TDF) as first-line treatment in low and middle income countries? This question will be addressed by data presented from the phase III ADVANCE trial, which compares TAF/DTG/emtricitabine (FTC), TDF/DTG/FTC, and TDF/FTC/efavirenz (EFV) for first-line treatment in South Africa.
There will also be data on ART switch and simplification strategies. Previous data on switching to a 2-drug DTG regimen when patients achieve an undetectable HIV-1 RNA are limited to relatively small studies. At IAS 2019, we will see new data through Week 24 from the large TANGO study that will suggest switching to a DTG plus 3TC fixed-dose combination is noninferior to continuing a TAF-based regimen in maintaining virologic suppression in these patients.
One method of ART simplification is the reduction of the number of doses required per week. Can ARVs given fewer than 7 days per week maintain viral suppression? The previously published FOTO study demonstrated that in select patients, EFV-based regimens could be given 5 days on with 2 days off and still maintain undetectability. At IAS 2019, we will see data from the phase III ANRS 170 QUATUOR study, which assesses a 4 out of 7 days maintenance strategy.
It will be interesting to see how much of this first-line and switch data will affect HIV guidelines and, particularly, if 2-drug regimens will become recommended and/or preferred strategies.
The proposed association between INSTIs and weight gain has little randomized trial data to support it. The NEAT 022 study demonstrated weight gain out to 48 weeks in individuals who switched to DTG compared with those who continued on PI-based treatment. We will now see data from 2 large, randomized phase III trials—the ADVANCE and NAMSAL trials—that will provide additional data on weight gain with INSTIs and/or TAF. In addition, these trials have enrolled a large number of black women, a demographic that may be at greater risk for weight gain on INSTIs.
Pregnancy and Neural Tube Defects IAS 2019 will feature important data on the association of DTG with neural tube defects, including the next round of results from the Tsepamo study in Botswana, which first alerted the world to a possible link. Additional data from Botswana as well as data from Brazil, Uganda, and the Antiretroviral Pregnancy Registry will also be presented. Consequent to these data, we wait in anticipation for the new WHO treatment guidelines, which are aimed to be released during IAS 2019.
PrEP and Biomedical Prevention Key new data on pre-exposure prophylaxis (PrEP) will also be presented. Of particular interest will be the updated results from the phase III DISCOVER trial comparing TAF with TDF for HIV PrEP. Is PrEP with TAF effective? Do the bone mineral density and renal function benefits of TAF as treatment in people with HIV also apply to TAF as PrEP in people without HIV?
Also, as the field moves toward new drug delivery systems, the results of the first human trial of MK-8591–eluting implants for HIV prophylaxis will be important.
In addition, there will be new data from studies investigating PrEP retention in various special populations, which will provide important information for programs to remain effective and sustainable.
HIV/TB Coinfection IAS 2019 will be the stage for Week 48 data from the ANRS 12300 Reflate TB2 trial, a major study assessing virologic efficacy of raltegravir 400 mg BID vs EFV 600 mg QD, both in combination with TDF and 3TC, in adults with HIV infection and tuberculosis (TB). This study is a larger follow-up to ANRS 12 180 Reflate TB, which investigated 400-mg BID and 800-mg BID doses of raltegravir. These will be important data, as the best data we have to date in HIV/TB treatment support EFV as the preferred regimen, which globally has a diminishing role in treatment.
Cure In addition to the major topic areas described above, there will also be a great deal of interesting basic science work presented.
In the cure arena, we will see safety and pharmacodynamic data for vesatolimod, an oral toll-like receptor 7 agonist that could be combined with neutralizing antibodies or a vaccine in future cure strategies.
Important advances are also being made in broadly neutralizing antibodies (bNAbs). The AIDS Clinical Trials Group will present data from a single-dose phase I study assessing safety and efficacy of the HIV-1 bNAbs VRC01LS or VRC07-523LS in adults with HIV infection, which will be important for the potential use of these antibodies in cure strategies.
I’m also looking forward to the results of the ASCENT study, which will provide data evaluating HIV vaccines.
Other Important Issues There will be several sessions on implementation and prevention science. These sessions will include data from studies such as PopART, which assessed test-and-treat strategies in Africa, and other studies highlighting specific key populations. Of importance, there will also be special sessions discussing the HIV response in areas of conflict and in specific regions, including a discussion on how Latin America and the United States plan to end their HIV epidemics.
The goal of the IAS 2019 conference is to shape treatment and prevention strategies and pave the way for effective test-and-treat approaches. Overall, it will highlight inequality and stigma and be a catalyst for collaboration, innovation, and a sustainable response to the HIV epidemic.
As the meeting unfolds, remember to check the CCO Web site often for downloadable slidesets summarizing the data from these and other studies and plan to join us for a series of live Webinars hosted by expert faculty providing their take on the clinical implications of the data. After the meeting, look for more ClinicalThought™ commentaries featuring expert perspectives on integrating new data into practice.
These Terms of Use ("Terms") apply to your use of the websites, mobile applications and other resources provided by Clinical Education Alliance LLC (“CEA”) and its affiliates (referred to collectively as "CEA," "us," "we" and "our") that are intended for use by healthcare professionals, which we refer to as the "CEA Network," including the personalized information and services that meet the needs and interests of users of the CEA Network such as medical news, reference content, clinical tools, applications, sponsored programs, advertising, email communications, continuing medical education, market research opportunities and discussion forums (collectively, the "Services"). You will always be able to view the most current version of these Terms by clicking on the Terms of Use link at the bottom of any page of a CEA Network property. Note that these Terms do not apply to our properties and services that display a link to different terms of use. In the event that we expand the CEA Network through our acquisition of another company and/or its properties, that company may operate its properties subject to its own terms of use accessible via a link on such properties until we integrate its practices with ours, at which point a link to these Terms will be displayed on its properties. By using the Services, you agree to these Terms, whether or not you are a registered member of the CEA Network. These Terms govern your use of the Services and create a binding legal agreement that we may enforce against you in the event of a violation. If you do not agree to all of these Terms of Use, do not use the Services!
We reserve the right to change these terms from time to time. The most current version may be viewed by clicking on the “Terms of Use” link at the bottom of designated pages on the Clinical Education Alliance Sites. Use of the Clinical Education Alliance Sites after the effective date constitutes acceptance of the amended Terms of Use. When you leave a CEA Web site and go to another Web site, different terms apply and CEA has no responsibility or liability for any content on those sites.
The Clinical Education Alliance Sites incorporate information, including modules, capsules, journal articles, medical news, references, interactive case studies, other continuing education material, downloadable software applications, advertising, and other healthcare information, which is intended for adults who are licensed healthcare professionals. This information is not intended to serve as a substitute for the healthcare professional’s clinical judgment. If you are a consumer who chooses to read this professional-level information on Clinical Education Alliance Sites, you should not use or rely on that information as professional medical advice or use it to replace any relationship with your physician or other qualified healthcare professional or any information they may have provided to you. For medical issues or concerns, including decisions about medications and other treatments, consumers should always consult their physician or, in serious cases, seek immediate assistance from emergency personnel.
The Content on the Clinical Education Alliance Sites is developed or selected in accordance with our published Editorial Policies. However, users access and use this material at their own risk. It is the reader’s job to evaluate the accuracy of any information and results from interactive programs found on the Clinical Education Alliance Site. If you are a healthcare professional, you should rely on your professional judgment in evaluating any and all information and confirm the information contained on the Clinical Education Alliance Sites with other sources and reliable third parties before basing any treatment or advice on it. If you are a consumer, you should evaluate the information together with your physician or another qualified healthcare professional.
THE CONTENT, APPLICATIONS, SOFTWARE, AND ALL OTHER MATERIAL ON THE CLINICAL EDUCATION ALLIANCE SITES ARE PROVIDED “AS IS” AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NONINFRINGEMENT. ALL WARRANTIES, EXPRESS OR IMPLIED, ARE HEREBY DISCLAIMED. CLINICAL EDUCATION ALLIANCE SHALL NOT BE LIABLE FOR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, PHYSICAL HARM OR INJURIES, LOST REVENUES, OR LOST PROFITS, RESULTING FROM THE USE OR MISUSE OF THE CLINICAL EDUCATION ALLIANCE SITES, OR ANY INFORMATION, APPLICATIONS, MATERIALS, OR SOFTWARE THEREON, EVEN IF CLINICAL EDUCATION ALLIANCE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR FOR ANY CLAIM BY ANOTHER PARTY. CLINICAL EDUCATION ALLIANCE DOES NOT WARRANT THAT THIS SITE OR ANY APPLICATIONS OR SOFTWARE WILL BE FREE OF BUGS, INACCURACIES, OR ERRORS, NOR DOES CLINICAL EDUCATION ALLIANCE WARRANT THAT ANY SITE, SOFTWARE, OR APPLICATION IS FREE OF VIRUSES OR OTHER HARMFUL ELEMENTS.
A user’s use of the Clinical Education Alliance Sites, and any reliance on any materials, information, software, or applications, is at the user’s own risk. You agree that you hereby release Clinical Education Alliance and its affiliates, owners, respective directors, officers, employees, advertisers, authors, and contributors from any and all liability or obligations arising from the use of the Clinical Education Alliance Sites. A user’s sole remedy for any problem or concern is to exit the Web site or application. You agree that you will indemnify and hold Clinical Education Alliance harmless for any loss, damages, or liability suffered by Clinical Education Alliance as a result of your use of any Clinical Education Alliance Site or material, application, information, or software thereon or your submission of any material to Clinical Education Alliance. Clinical Education Alliance reserves the right to restrict or limit access to this Web site.
The Clinical Education Alliance Sites include interactive programs, clinical tools, and databases intended for the use of healthcare professionals. These materials are not intended as professional advice or recommendations of particular products. Physicians and other healthcare professionals who use our interactive programs, tools, or databases should exercise their own clinical judgment as to the results. Consumers who use the tools or databases do so at their own risk.
Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. For medical concerns or issues, including decisions about medications and other treatments, users should always consult their physician or other qualified healthcare professional.
The entire contents and design of the Clinical Education Alliance Sites, including the software applications, tools, and databases, are protected under US and international copyright laws. These materials are owned by CEA or its affiliates or are used with permission of their owners or as otherwise authorized by law. All rights are reserved, worldwide. You may look at the Clinical Education Alliance Sites, download individual articles or applications to your personal computer or handheld device, and print a reasonable number of pages for your own personal reference. You must not remove any copyright notices from our materials. We reserve all our other rights. This means you may not sell, rewrite, or modify any content or other material found on any Clinical Education Alliance Site, redistribute it, put it on your own Web site, or use it for any commercial purpose without our prior written authorization.
The names of the CEA products and services are protected by trademark laws in the United States. Any use of our trademarks or service marks requires prior written approval from CEA.
You may link to a CEA Web site if your Web site offers products, services, or information of interest to the professional healthcare community. You are not allowed to link to the Clinical Education Alliance Sites if you post illegal, obscene, or offensive content or if the link is likely to have a negative impact on CEA’s reputation. Any other use, such as framing any part of a CEA Web site or incorporating any CEA content into another Web site, product, or application, requires advance written permission from Clinical Education Alliance. Clinical Education Alliance assumes no responsibility for any Web sites or materials that are linked to Clinical Education Alliance Sites or materials.
Clinical Education Alliance makes some software and accompanying documentation available for downloading from our Web sites and/or from iTunes. These materials are protected by copyrights under US and international law and are owned by Clinical Education Alliance or companies that have licensed the software to us. We do not transfer any ownership rights in software or documentation to you when you download it from our Web site and/or directly from iTunes. You may use the software and accompanying documentation for their intended purpose. You are not authorized to further copy or distribute the software and accompanying documentation, nor may you attempt to recreate or reverse engineer our software or applications. In addition, some software available for downloading from our Web sites and/or from iTunes is subject to US export controls. By downloading or using such software, you are representing to us that your download of such software complies with these controls.
If you are affiliated with the US government, please note that the software and documentation available on our Web sites and/or directly from iTunes are “commercial items,” as that term is defined in 48 C.F.R. 2.101 (October 1995), consisting of “commercial computer software” and “commercial computer software documentation,” as such terms are used in 48 C.F.R. 12.212 (September 1995). Consistent with 48 C.F.R. 12.212 and 48 C.F.R. 227.7202-1 through 227.7202-4 (June 1995), all US government end users acquire the software and documentation with only those rights set forth herein.
Clinical Education Alliance offers users the opportunity to engage in social media interactions with both experts and other users of the sites. As with other online social media, users must exercise sound judgment in both the information that they post and in how they assess the postings of other users. As such, users are expected to adhere to the social media recommendations made by the American Medical Association when utilizing the social media capabilities of CEA sites. In particular, users must be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments and must not post identifiable patient information on CEA sites. In social media interactions, users must maintain appropriate boundaries of the patient–physician/care provider relationship in accordance with professional ethical guidelines just as they would in any other context. Users acknowledge that privacy settings are not absolute and that once on the Internet, content posted by them may be copied by third parties and republished out of the control of Clinical Education Alliance. Thus, users should routinely monitor their own Internet presence to ensure that the personal information and content that they post and, to the extent possible, that is posted about them by others is accurate and appropriate.
Users are expected to refrain from submitting comments or messages that are defamatory, hateful, or obscene or that harass others. Users may not impersonate any other person or violate any other person’s or entity’s legal rights or submit falsified credentials or experiences. Users agree that they will not submit any materials that violate or infringe any copyrights, trademarks, patents, trade secret, or other intellectual property rights of any third party. Clinical Education Alliance retains all copyrights in the content posted by users to its sites. Clinical Education Alliance may adopt additional rules to govern use of social media, message boards or forums, to which users will be subject.
If you believe that any material on this Web site infringes your copyright, please notify us as follows, under the Digital Millennium Copyright Act (“DMCA”). To notify us, the DMCA requires that you: 1. Send an email notice to Clinical Education Alliance at customersupport@clinicaloptions.com. 2. Include the following information in your email: a. Identify the copyrighted work(s) you claim is infringed; b. Identify the material you claim is infringing the copyright(s) and give enough information for Clinical Education Alliance to locate that material; c. Include a physical or electronic signature of the copyright owner or a person authorized to act on the copyright owner’s behalf (the “Claimant”); d. Include the Claimant’s name, address, and telephone number(s); e. Include a statement that the Claimant has a good faith belief that use of the disputed material is not authorized by the copyright owner or his agent; and f. Include a statement, under penalty of perjury, that the information in the notification of copyright infringement is accurate and that the Claimant is the copyright owner or is authorized to act on behalf of the copyright owner.
If you believe any content or material on the Clinical Education Alliance Sites violates any laws, please notify customersupport@clinicaloptions.com. Please include details about your concerns and an email address for contacting you.
Clinical Education Alliance controls the Clinical Education Alliance Sites from its offices in the state of Virginia in the United States of America. The Clinical Education Alliance Sites can be accessed from any of the United States and from other countries worldwide. Since the laws of each state or country may differ, both you and Clinical Education Alliance agree that the laws of Virginia, without regard to conflicts of laws principles, will apply to all matters relating to use of the Clinical Education Alliance Sites and materials, including software and applications.
Clinical Education Alliance makes no representation that materials on these sites are appropriate or available for use in countries aside from the United States. Accessing the Clinical Education Alliance Sites from territories where their contents are illegal is prohibited. Those who choose to access these sites from other locations do so at their own risk and are responsible for compliance with any and all applicable local laws or regulations.
By downloading or accessing materials on the Clinical Education Alliance Sites and/or directly from iTunes or registering with us, you agree to all the terms and conditions in this agreement, including the Terms of Use and Privacy Policy. If you disagree with any of these Terms of Use or Privacy Policy, please refrain from using the Clinical Education Alliance Sites or materials.
Because we provide education for healthcare professionals, we pay special attention to privacy issues. The purpose of our Privacy Policy is to identify the information we may collect about you, describe the uses we may make of your information and the security measures we take to protect it, and discuss your options for controlling your information. You can review our Privacy Policy by clicking on the “Privacy Policy” link at the bottom of designated pages on the Clinical Education Alliance Sites.
If you fail to comply with these terms, we have the right to suspend or eliminate your account and remove any information you have placed on our site, including your registration information. We may also take any legal action we think is appropriate. If there is any dispute between us concerning this agreement or your use of any Clinical Education Alliance Site or materials or applications, we both agree to submit the dispute to nonbinding mediation, followed by binding arbitration. Both the mediation and the arbitration will be governed under the rules of the American Arbitration Association, and the venue for the arbitration will be Virginia.
For questions or concerns about these Terms of Use, please send an email to customersupport@clinicaloptions.com
These terms of use were last updated in July 2021.
You are leaving the site. The new destination site may have a different terms of use and privacy policy.
We've updated our ad policy. Please review our policy here. Click 'Agree' to accept. If you do not accept, you cannot proceed to the site.
By clicking "Agree," you are agreeing to our Privacy Policy, Terms & Conditions and Ad Policy.
Back
