AIDS 2020 (July 6–10) may not have made it to Oakland and San Francisco, but the reconfigured virtual conference still contained an abundance of science and activism.
Impact of COVID-19
Many talks focused on challenges of adapting HIV services to COVID-19 lockdowns. Elyse Tung (Kelley-Ross Clinic, Seattle, WA, USA) highlighted the role US pharmacists could have in increasing access to pre-exposure prophylaxis (PrEP), with a switch to providing TelePrEP in less than a week. Tham Thi Tran (PATH, Vietnam) and Tin Lu (Glink, Vietnam) discussed the importance of involving key-populations in PrEP programming and provision during lockdown with the use of home-based HIV testing and couriers to supply treatment. Ivan Magala (The AIDS Support Organization [TASO], Uganda; abstract OAELB0101) described community antiretroviral therapy (ART) provision by TASO in Masaka. Expertise gained in dealing with HIV have also been turned to the COVID-19 response. Charles Atem (Clinton Health Access Initiative, Cameroon), Omo-Emmanuel Ughweroghene Kingston (USAID, Nigeria), and Raiva Simbi (Ministry of Health, Zimbabwe) discussed experiences of optimising diagnostics networks for HIV and tuberculosis and adaptation of these to SARS-CoV-2.
Long-acting injectable PrEP
Long-acting PrEP is one step closer with results from the HPTN083 trial of cabotegravir injections presented by Raphael Landovitz (University of California, Los Angeles, USA; OAXLB0101). The blinded trial compared daily oral tenofovir disoproxil fumarate with emtricitabine or, following an oral lead-in, intramuscular long-acting cabotegravir injections every 8 weeks in cisgender men and transgender women who have sex with men. The blinded part of the study was stopped early after interim analysis by the data and safety monitoring board. There were 52 new HIV infections during the trial, 13 in the cabotegravir group (incidence rate 0·41%) and 39 in the tenofovir disoproxil fumarate with emtricitabine group (incidence rate 1·22%). Long-acting cabotegravir was statistically superior. The results of HPTN084, a parallel study in cisgender women in sub-Saharan Africa, are eagerly awaited to see if long-acting cabotegravir is equally effective as PrEP in this group. Ongoing questions on the pharmacokinetic tail-phase of cabotegravir and its implications for resistance remain.
Weight gain continued
Simiso Sokhela (University of the Witwatersrand, Johannesburg, South Africa; OAXLB0104) presented the 96-week data from the ADVANCE study, of either tenofovir alafenamide or tenofovir disoproxil fumarate given with emtricitabine and dolutegravir compared with standard care of tenofovir disoproxil fumarate, emtricitabine, and efavirenz. Weight gains in all groups (seen previously in 48-week data) continued to 96 weeks and 144 weeks (although the 144-week data were incomplete). Gains were larger in women than in men, and were largest in the tenofovir alafenamide group (where women had an average weight gain of 8·2 kg at 96 weeks). In addition, statistically significant treatment emergent metabolic syndrome was seen in the tenofovir alafenamide group. Patrick Mallon (University College Dublin, Ireland; OAB0604) presented data from participants in the US OPERA cohort, which switched from tenofovir disoproxil fumarate to tenofovir alafenamide. In those switching, an early pronounced gain in weight occurred, regardless of regimen, and plateaued after 9 months.
Dolutegravir in pregnant women
There was good news from the Tsepamo study in Botswana. Rebecca Zash (Beth Israel Deaconess Medical Center, Boston, MA, USA; OAXLB0102) presented results up to April 30, 2020. There have now been seven neural tube defects recorded in women using dolutegravir at conception, giving a prevalence of 0·19% (vs 0·11% to those on other forms of ART and 0·07% in women without HIV). Since the original safety signal, the prevalence of neural tube defects in women taking dolutegravir at conception has continued to decline.
A possible cure?
Long-term HIV remission in a participant enrolled in a trial to decrease viral reservoirs was presented by Ricardo Diaz (Universidade Federal de São Paulo, Brazil; OAXLB0105). The Brazilian man was one of five participants who took an intensified ART regimen consisting of their usual ART plus dolutegravir and maraviroc alongside nicotinamide for 48 weeks. After regimen intensification, participants resumed standard ART and then had an analytical treatment interruption. The participant with long-term remission was the only one to have viral blips during treatment intensification, possibly representing reactivation of the viral reservoir. He has now had undetectable viral load for over 64 weeks and follow-up will continue. Investigation of the role of agents with potential to reverse latency, such as nicotinamide, is ongoing.For AIDS 2020 see https://www.aids2020.org/