East Bay Getting to Zero
Clinical Guides, Data, Epidemiology, HIV treatment, Research
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CROI 2022, the conference on the latest updates on global HIV research, took place February 13-16. Below are a few key resources and highlights:

HIV treatment and cure highlights from CROI 2022:

  • Third case of documented HIV cure was highlighted in the IMPAACT study. All three known HIV cure cases had blood cancers and needed chemotherapy, radiation and transplant for cancer treatment. This case is unique because it’s the first woman of mixed race who received the treatment in the US (NYC), and got a cord blood transplant rather than an adult bone marrow or blood transplant. She has done clinically well, with no graft-versus-host-disease, unlike the other two cases who got bone marrow or adult stem cell transplants (Timothy Brown, treated in Berlin, and Adam Castillejo, treated in London). Her viral load remained undetectable 14 months after stopping ART, and she’s been in remission from AML for 4+ years. This treatment has a 30% risk of death, so it’s very risky not something that we can do for people who don’t need it for another condition, like a blood cancer. However, it does bring up potential mechanisms that can be studied for potentially safer ways to pursue cure treatments. 
  • The ANCHOR study showed that screening and treatment for anal dysplasia reduced anal cancer incidence by 57% over a median of just over 2 years. This is a reminder to continue/strengthen anal pap screening and HRA referrals! Some of you may know this SF-based study well, as you referred and/or participated in it. This study was stopped early because it quickly became clear that anal pap screening, HRA and treatment for HSIL (93% treated with electrocautery) was effective in preventing anal cancer. Over a median of 26 months, 30 anal cancers were detected, 9 in the treatment group and 21 in the observation group, for a 57% reduction. This will likely lead to guidelines updates recommending regular anal cancer screening with anal paps, HRA for dysplasia, and treatment (electrocautery or IRC) for HSIL.

HIV antiretroviral treatment (ART) studies:

  • The CAB-RPV ATLAS-2M study found that injectable CAB-RPV given every 8 weeks was non-inferior to when it was given every 4 weeks over a period of 3 years with an >85% overall viral load suppression rate, leading to the FDA updated approval for giving it every 8 weeks.
  • The DTG-3TC TANGO switch study found that in patients virally suppressed on a 3-drug regimen, switching to DTG+3TC was non-inferior at 96 weeks (almost 2 years) of follow-up. 
  • Several ART studies in resource-limited settings found that DTG-based regimens worked well in first, second and third-line regimens compared to NNRTI and PI-based regimens, and TDF did better than AZT in NNRTI treatment failure, even with K65R resistance mutations.
  • A US-based study on DTG (dolutegravir or Tivicay) in pregnancy using a huge pregnancy data-set found that there was no increased rate of neural-tube defects associated with DTG use in the US, where folic acid is added to many food products containing grains (unlike in Bostwana, where they saw more neural tube defects). The IMPAACT group also found that DTG was better than EFV for sustained viral load suppression in pregnancy and post-partum, as well as associated with less stunting in infant growth. 
  • Studies on the new ART agents:
    • Islatravir (ISL) long-acting translocation inhibitor (NRTTI) studies found that oral, long-acting injectable, treatment and PrEP versions were associated with lymphopenia (up to 30% reduction in CD4 counts) despite viral load suppression, so the FDA placed a clinical hold on these studies so the lymphopenia can be investigated. 
    • Lenacapravir (LEN) long-acting capsid inhibitor:
      • The CALIBRATE study found that LEN given sub-cutaneously (SC) every 6 months along with daily oral ART had 85-90% viral load suppression after 1 year, similar to other first-line ART regimens.
      • The CAPELLA study found that for people with multi-drug resistant HIV (resistance to at least 2 classes of HIV ART), adding LEN to their regimen led to 94% viral load suppression among those with 2 other active drugs and 79% in those with one other active drug at the 2-year follow-up mark. 
      • The FDA did not approve LEN for MDR HIV due to some issue with the glass vials it is stored in. The manufacturer is now addressing the glass vial problem and hopefully will re-submit for FDA approval for people with MDR HIV for whom there are few or no other treatment options.