In this online meeting, Shivash from ViiV provided an update about key studies reported at the HIV Drug Therapy Conference in Glasgow in November 2024.
TON online meeting 28th November 2024
We were fortunate to have Shivash from ViiV who provided an update in relation to key studies reported at Glasgow 2024 and previous conferences. Shivash shared that it is his personal wish and the mission statement of ViiV to put themselves out of employment by work nonstop until a cure is found for HIV. In the interim they hope to provide information and treatments that hopefully offer people with HIV a range of choices to live their best lives.
What’s new?
Recent years have seen trends towards treatment combinations containing only two medications with benefits including reduced pill burden and side effects, reduced costs to government funders and avoiding side effects of certain medication while also maintaining highly effective suppression of HIV. Dovato is one fixed dose combination that contains dolutegravir (DTG) and lamivudine (3TC). It is effective both people starting treatment for the first time as well as for treatment experienced people switching from combinations containing three drugs.
What do the studies say?
In the GEMINI, STAT, TANGO & SALSA studies Dovato suppressed HIV just as effectively as known three-drug combinations. Interestingly in the PASO-DOBLE study Dovato demonstrated an equal level of viral suppression, with less weight gain for Dovato users.
It is important to remember that weight gain for people with HIV is complex and multifactorial and involves a range of factors including gender, race, diet, exercise, mental health and drug and alcohol use. Even though some treatments may contribute to weight gain it is important to consider all contributing factors when talking to people with HIV about weight.
Ability of Dovato to suppress VL to undetectable levels at less than 50 copies as a percentage and compared with three drug treatment combinations.
In the DOLCE and D2DARLING Studies Dovato demonstrated similar ability to achieve undetectable viral loads for both treatment experienced and people starting treatment for the first time, including people with high viral loads and low CD4 counts who had no baseline resistance testing. This is great news for areas with less funding or limited access to expensive blood genotype resistance testing.
Long-acting HIV treatment
Cabenuva is a long-acting injectable option consisting of only two HIV treatments; cabotegravir and rilpivirine, that are given by injection every two months. Cabenuva is the only full treatment combination that addresses stigma by removing the need to take daily oral medication thereby eliminating the need for daily pills thereby removing the risk of others finding out your status by finding your pills.
People taking cabenuva report improved quality of life with not needing to take pills every day, not needing to fill prescriptions and not having to take pills with them on holiday or when they go out, allowing them to be spontaneous with their social lives.
Cabenuva Studies:
In the FLARE, ATLAS and ATLAS-2M studies demonstrated ability of cabenuva to maintain viral load suppression for people switching from oral antiretroviral therapy to long-acting injections.
Percentage of people maintaining undetectable viral load (top row in dark blue) when switching to cabenuva from oral HIV treatment. Percentage in bottom row in light blue indicates number of people with viral breakthrough owing to resistance.
The SOLAR, CARES, and LATITUDE Studies investigated the effectiveness of Cabenuva in different populations, including people less able to regularly visit services to pick up pills, take pills daily and those in resource-limited settings. These studies highlighted the potential of long acting injectables to reduce stigma, support adherence and maintenance of undetectable viral load, and self-reported treatment satisfaction.
The GLACIER Study investigated the possibility of administering Cabenuva in outside clinics, or Alternative Sites of Care (ASOC), including community pharmacies to help reduce stigma and improve convenience for patients. People also reported that injections offer ‘treatment discretion’ and resulted in reduced stigma by removing the need for daily pills.
Self-reported rates of satisfaction of people receiving cabenuva 2 monthly injections.
The LATITUDE and CARES studies showed the benefits of long acting injectables for people with adherence issues. Barriers to adherence include income, mental health, drug and alcohol use, unstable housing, no housing, poor understanding of importance of adherence to maintain undetectable viral load and prevent related health issues.
Overall, the main concern reported with Cabenuva is injection site reactions which can cause temporary discomfort, although this dramatically improves after the first or second occasion of administration. In very rare cases resistance has been observed even when resistance blood testing has been performed before people commenced Cabenuva. In these rare cases viral load is easily resuppressed with other modern treatment combinations.
Other news
- Ultra-Long Acting Cabenuva: Trials are underway for injections every four months instead of every two. This could be great news for prep and possibly treatment, especially if able to be paired with other ultra long-acting HIV treatments. Studies may start enrolling in Australia in as soon as 2025.
- Fostemsavir is a novel oral entry inhibitor. While not PBS listed it is available for free via compassionate access for people in Australia with resistant HIV.
- There are plans to trial self-administration of long-acting injectable HIV treatment at home both as treatment and PrEP, with a view that this could be the future of HIV treatment for some.
- Dolutegravir dispersible tablets provide an option for infants, children and people with swallowing difficulties.
