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The following reflects new findings and outcomes in medical research as presented at major medical meetings and published peer-reviewed medical journals. In this section members can view reports from important congresses as well as summaries of some recently published journal articles. Please let us know if you have a particular area of interest you would like to see covered. NEW FRONTIERS - XVIII International AIDS Conference (IAS) Seeking Optimal First-line NRTI Backbones: Weighing the EvidenceVienna, Austria / July 18-23, 2010 Vienna - Prior efforts to rank nucleoside reverse transcriptase inhibitor (NRTI) combinations by safety are being confounded by an evolving understanding of lifetime risks in an aging HIV-infected population. The relative risks posed by NRTIs on specific organ systems over time have required frequent reassessment as new data have been generated by the increasing population of long-term HIV survivors. However, because the spectrum of long-term risks on NRTIs differs, it is inappropriate to (...) Read more... PRIORITY PRESS - XVIII International AIDS Conference (IAS) Relative Strengths and Clinical Use of CCR5 Entry InhibitorsVienna, Austria / July 18-23, 2010 Vienna - The expansion of antiretroviral drug classes is permitting a far more strategic order of first-, second- and third-line treatments. After a long period in which cross-resistance within classes produced a situation in which newer therapies were often reserved for salvage, the expansion of new drug classes, such as fusion inhibitors, entry inhibitors and integrase inhibitors, are permitting a far more individualized approach. In general, the recommended treatment for initial therapy (...) Read more... NEW FRONTIERS - 19th Annual Canadian Conference on HIV/AIDS Research (CAHR 2010) Close-Up on NRTI Backbones: Current Evidence with Preferred RegimensSaskatoon, Saskatchewan / May 13-16, 2010 Saskatoon - The decision by the U.S. Department of Health and Human Services (DHHS) to identify the combination of tenofovir (TDF) and emtricitabine (FTC) as the only preferred nucleoside reverse transcriptase inhibitor (NRTI) backbone for initial antiretroviral therapy (ART) is not consistent with available data and has not been followed by other major guidelines. The DHHS decision to remove abacavir (ABC) and lamivudine (3TC) from the list of preferred NRTI combinations was based on a (...) Read more... PRIORITY PRESS - 19th Annual Canadian Conference on HIV/AIDS Research (CAHR) Patient-Physician Communication in HIV Care: Opening the DialogueSaskatoon, Saskatchewan / May 13-16, 2010 Saskatoon - Successful long-term care of patients living with HIV is built upon good communication. Without open and honest dialogue between physicians and patients, physicians cannot fully appreciate what patients are experiencing. Patients also need to be able to convey their experience as it relates to antiretroviral therapy (ART) clearly so that their concerns may be discussed with their physician. Results from a Canadian study indicated that symptoms experienced as bothersome to the (...) Read more... MEDICAL FRONTIERS - 17th Conference on Retroviruses and Opportunistic Infections (CROI) Improved Tropism Testing Rapidly Expanding the Utility of CCR5 Antiretroviral AgentsSan Francisco, California / February 16-19, 2010 San Francisco - The entry inhibitor antiretroviral agents known as CCR5 antagonists are in a position to assume a much more prominent place in HIV management as a result of easier tropism screening. A series of studies with tropism testing that has improved sensitivity for R5 virus (virus using the CCR5 co-receptor) has confirmed that CCR5 antagonists are highly potent with a unique resistance profile. CCR5 inhibitors are soon to be even easier to use in Canada and elsewhere because of (...) Read more... PRIORITY PRESS - 17th Conference on Retroviruses and Opportunistic Infections (CROI) Enhanced Tailored Therapy in an Aging HIV PopulationSan Francisco, California / February 16-19, 2010 San Francisco - Antiretroviral therapies (ART) are being rapidly differentiated for their long-term effects on a variety of organ systems threatened in aging individuals. While most patients adherent to ART can now expect to survive their HIV infection, it is now clear that the specific agents within an antiretroviral regimen need to be individualized. The evidence suggests that antiretroviral agents contribute to a broad list of progressive diseases in a variety of organs, including the (...) Read more... PRIORITY PRESS - 12th European AIDS Conference A Holistic Approach to Management of HIV and Comorbidities: A Treatment ContinuumCologne, Germany / November 11-14, 2009 Cologne - Now that HIV infection is generally controllable, attention has turned to a spectrum of pathologic processes that appear to be accelerated in an HIV population. Conditions generally recognized as age-related in the non-HIV population, such as cardiovascular disease, cognitive dysfunction, renal impairment and osteoporosis, are occurring at an earlier age in those with HIV infection. Although no goal is more important to long-term survival than controlling HIV infection, the (...) Read more... PRIORITY PRESS - 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) Long-Term Data Associate CCR5-Inhibitors with Encouraging Tolerability ProfileSan Francisco, California / September 12-15, 2009 San Francisco - For most antiretroviral agents the weakness has been characteristic adverse effects. These may include acute complaints, such as gastrointestinal (GI) side effects, or worrisome laboratory changes that raise concern about long-term safety, such as elevated lipids or liver enzymes. New long-term data with CCR5 inhibitors suggest that these agents may be among the most well tolerated of any antiretroviral class so far. Both the currently licensed agent and a CCR5 inhibitor (...) Read more... PRIORITY PRESS - Fifth International AIDS Society (IAS) V3 Genotyping as a Screening Option for HIV Tropism: MOTIVATE and MERIT RevisitedCape Town, South Africa / July 19-22, 2009 Cape Town - Entry inhibitors are one of the most promising concepts in the evolution of antiretroviral therapy. By preventing HIV from entering host cells, these treatments can block the very first step in retroviral reproduction. In clinical trials, both an injectable cell surface attachment inhibitor and an oral inhibitor of receptor binding have proven effective in treatment-naive and treatment-experienced patients when they are combined with other effective agents. An estimated 80% of (...) Read more... NEW FRONTIERS - Fifth International AIDS Society (IAS) Goals of HIV Control in Aging PopulationsCape Town, South Africa / July 19-22, 2009 Cape Town - Accumulating evidence suggests the aging process is accelerated in patients with HIV. Even among patients whose infection is well controlled, age-related diseases of the heart, kidney, brain, and other organ systems are being diagnosed earlier than would be expected in the absence of HIV. This, along with new treatments, was an area of intense interest here at the 5th IAS meeting. To provide HIV patients with a life expectancy commensurate with a non-infected population, two (...) Read more... PRIORITY PRESS - Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention Chronic Control of HIV from the Perspective of Quality of LifeCape Town, South Africa / July 19-22, 2009 Cape Town - In an important shift in progress, the development of new antiretrovirals offer the potential to keep ahead of human immunodeficiency virus (HIV) from the perspective of quality of life as well as resistance. The new integrase inhibitors and the oral entry inhibitors have generally demonstrated a level of tolerability that rivals or exceeds that of many of the first antiretroviral classes. Newer agents within these classes are now preserving characteristics important to (...) Read more... PRIORITY PRESS - Fifth International AIDS Society (IAS) R5 Entry Inhibition with Enhanced-sensitivity Tropism AssayCape Town, South Africa / July 19-22, 2009 Cape Town - Efficacy of traditional antiviral treatments is due to their capacity to inhibit viral replication after the virus penetrates the CD4 T-cell. The advent of entry inhibitors, blocking HIV from getting into the cell, has significantly increased the potential in reaching low or undetectable viral loads. However, the pill burden, interactions and adverse events of combination therapy are still a challenge. Using an enhanced-sensitivity Trofile assay, a new analysis of the MERIT (...) Read more... NEW FRONTIERS in MEDICINE HIV/AIDS - 18th Annual Canadian Conference on HIV/AIDS Research (CAHR) Extending the Length and Quality of Life of HIV Patients Beyond Disease ControlVancouver, British Columbia / April 23-26, 2009 Vancouver - One of the most important current challenges in HIV care is decelerating aging processes driven by the infection or by the treatments. In age-matched comparisons, the presence of HIV is associated with increased rates and severity of an array of age-related conditions, including coronary artery disease (CAD), cognitive dysfunction, renal impairment and bone loss. These threaten both quality of life and life expectancy. Although sustained control of HIV remains the single most (...) Read more... PRIORITY PRESS - 7th European HIV Drug Resistance Workshop The CCR5 Entry Inhibitors: Rethinking Antiviral Restrictions for Treatment-experienced PatientsStockholm, Sweden / March 25-27, 2009 Stockholm - The need to employ CCR5 (R5) entry inhibitors only when HIV infection is CXCR4 (X4)-negative is being reconsidered. New data suggest R5 entry inhibitors retain efficacy against viruses that demonstrate low levels of X4 tropism, a finding particularly relevant to treatment-experienced patients with diminishing options for antiretrovirals. The importance of more precisely characterizing chemokine receptor tropism is emerging at the same time that a variety of new assays are (...) Read more... PRIORITY PRESS - 16th Conference on Retroviruses and Opportunistic Infections (CROI) The Significance of NRTI Selection: Managing Relative Risks While Maintaining Disease ControlMontreal, Quebec / February 8-11, 2009 Montreal - Most guidelines list first-line nucleoside reverse transcriptase inhibitors (NRTIs) as a combination of abacavir and lamivudine (ABC/3TC) or tenofovir and emtricitabine (TDF/FTC). For each, footnotes typically specify relative risks. The challenge for clinicians is to place these risks in context. Although the renal dysfunction associated with TDF is a serious concern with the potential to limit long-term survival, baseline susceptibility to renal disease is an important (...) Read more... NEW FRONTIERS in MEDICINE HIV/AIDS - 16th Conference on Retroviruses and Opportunistic Infections (CROI) Cognitive Deficits in an Aging HIV PopulationMontreal, Quebec / February 8-11, 2009 Montreal - Research from several groups has converged to identify neurocognitive impairment as a rapidly growing problem in HIV-positive patients despite combination antiretroviral therapy (CART). Neurocognitive impairment is expected to grow in prevalence because the risk has been found to be cumulative over the course of infection. Although the risk of neurocognitive deficits is increased by insufficient control of HIV replication in the cerebrospinal fluid (CSF), the poor correlation (...) Read more... PHYSICIAN PERSPECTIVE Viewpoint based on the following article: Arch Neurol 2008;65(1):65-70. HIV Replication in the CNS, Antiretroviral CNS Penetration, and Risk of Cognitive DeclineJanuary 2009 INTRODUCTION
PHYSICIAN PERSPECTIVE Viewpoint based on presentations from the HIV DART 2008 - Frontiers in Drug Development for Antiretroviral Therapies Oral CCR5 Antagonists: Recent Analyses of this New Antiretroviral Drug ClassRio Grande, Puerto Rico / December 9-12, 2008 INTRODUCTION
9th International Congress on Drug Therapy in HIV Infection (HIV9) Landmark MOTIVATE Trial: Analysis of Latest FindingsGlasgow, Scotland / November 9-13, 2008 Glasgow - Although the worldwide HIV epidemic is stabilising, it is doing so at “an unacceptable level,” with 2.7 million deaths annually, according to the United Nations program on HIV/AIDS. That continuing challenge was the major focus of this meeting. Highly active antiretroviral therapy (HAART) has had an enormous impact, but the HIV virus continues to evolve and evade each new HAART regimen. For HAART to overcome HIV, continuing development is vital. This was the context for the first (...) Read more... 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Disease Society of America Effective HIV Suppression and Simplified HIV Therapy: Not Mutually Exclusive Clinical GoalsWashington, DC / October 25-28, 2008 Washington, DC - Highly-active antiretroviral therapy is an effective weapon aimed at an elusive enemy that can rapidly adapt to shifting circumstances. The goal of therapy in treatment-naïve patients infected with HIV/AIDS is to knock down the virus rapidly and keep it suppressed by attacking the mechanisms of viral expansion and replication at multiple stages. But as several studies presented at the joint meeting show, that challenge must be balanced by the need to consider such issues as (...) Read more... |