Innovations and implementation of long-acting antiretroviral therapy

SY19

Symposium

Track B - Clinical science

CME accreditation

M4/Channel 6

26 July 10:30 - 11:30

Moderators

Anchalee AVIHINGSANON
HIV-NAT, Thai Red Cross AIDS Research Centre, Thailand
Janine TREVILLYAN
University of Melbourne, Australia

Long-acting antiretroviral therapy that does not require daily dosing represents a paradigm shift in the management of HIV. This symposium will highlight the latest advances in long-acting ART and focus on the implementation of currently available treatment. This will particularly be in harder to treat in vulnerable populations where data is unavailable on its efficacy and examine emerging or newly reported regimens that may have additional benefits for populations with HIV. The symposia will also encompass how these treatments can be implemented in low-, middle- and high-income countries.

Presentations
Rapporteur Summary

10:30 5 min	Introduction Anchalee AVIHINGSANON HIV-NAT, Thai Red Cross AIDS Research Centre, Thailand Janine TREVILLYAN University of Melbourne, Australia

10:35 10 min	Advances in LA-ART: New drugs and new methods of delivery Brenda CRABTREE Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico

10:45 10 min	Implementation in populations with suboptimal adherence Aadia RANA University of Alabama-Birmingham, United States

10:55 10 min	Implementation of LA-ART in low-middle-income countries in adults and adolescents: Possibilities and expectations of populations Carolyn MOORE Centre for Infectious Disease Research in Zambia, Zambia

11:05 25 min	Live Q&A Janine TREVILLYAN University of Melbourne, Australia Anchalee AVIHINGSANON HIV-NAT, Thai Red Cross AIDS Research Centre, Thailand Carolyn MOORE Centre for Infectious Disease Research in Zambia, Zambia Brenda CRABTREE Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico Aadia RANA University of Alabama-Birmingham, United States

AUTHOR

Sulggi Lee

SUMMARY

Following up on SY08 from Monday, this session reviewed current clinical trials evaluating long-acting therapies, including lenacapavir (LEN), islatravir (ISL), and broadly neutralizing antibodies (bNAbs) but also discussed in detail important challenges and considerations in implementing long-acting ART in populations with suboptimal adherence and/or in low- to middle-income countries (LMIC).

HIGHLIGHTS

Dr. Crabtree first reviewed currently approved long-acting injectable agents: cabotegravir/rilipivirine (CAB/RPV, q4 or q8 weeks as ART, q8 weeks for PrEP), LEN (first in class, capsid inhibitor, q6 months for resistant HIV treatment), and Ibalizumab (bNAb, q2 weeks for resistant HIV treatment), and reviewed new agents and combinations: ISL (long-acting oral NNRTI), ISL+LEN, and LEN+ bNAbs (teropavimab and zinirvimab). However, she also emphasized challenges, including CAB/RPV being contraindicated with pregnancy and hepatitis B, and the need for novel drug delivery technologies. Dr. Rana then discussed challenges in implementation among populations with suboptimal adherence and highlighted two promising studies. A study of 35 viremic PWH receiving CAB/RPV for compassionate use demonstrated 63% virologic suppression (median 10 months follow-up), and the Ward 86 Demonstration study demonstrated low virologic failure (1.5%, similar to FLAIR, ATLAS) among 57 viremic participants (median 33 days follow-up). The ACTG LATITUDE trial is now enrolling 350 participants to further this work. Dr. Moore’s talk emphasized additional challenges in implementing long-acting ART in LMIC, including lack of funding, suboptimal adherence, hepatitis B, and high rates of HIV resistance. While these novel therapies are now being studied for prevention, treatment and cure, barriers for future implementation will remain a challenge.

CRITICAL ASSESSMENT

Several exciting long-acting ART options are now being developed, including first in class drugs and combination therapies, to provide people living with HIV a wider array of options, similar to current advances in contraception. Nonetheless, these novel therapies need to be partnered with innovative drug delivery options and thoughtful implementation strategies to enhance medication adherence, reduce drug costs, simplify drug storage and delivery logistics, in order to be able to better serve individuals living in low- to middle-income countries and/or with suboptimal adherence.