engleski

What is new in HIV medicine in 2015?

In Croatia, a total of 1183 cases of HIV infections have been registered in the period 1985-November 2014. The epidemic can still be classified as a low-level epidemic, the domininat mode of transmission is sex between men (MSM). Recently there has been an increse in new infections in MSM including young persons. Care for HIV infected persons is centralized and all patients are treated at one center at the University Hospital for Infectious Diseases in Zagreb. Treatment recommendations continue to evolve, with recent emphasis on integrase inhibitors as part of the initial treatment regimen and efavirenz no longer being among the preferred choice in the DHHS guidelines. Treatment in now generally recommended in all persons with less than 500 CD4 cell per microliter. There are new data on preexposure prophylaxis. In a “real world” clinical trial called PROUD, pre-exposure prophylaxis (PrEP) with TDF/FTC in high risk gay men in London reduced HIV transmissions 86%. „Real world” since the participants knew if they were receiving active drug or not (randomized to start right away or delay 12 months) ; the delayed PrEP arm extensively used PEP, making the results even more impressive. Study stopped early due to efficacy. The IPERGAY (ha) study compared intermittent PrEP - two TDF/FTC’s before sex, one pill the next 2 days - to placebo, and was also stopped early. Efficacy of this “on demand” PreP was again 86%. There are new data on interferon-free regiments in HIV/HCV coinfected patients. In the ION-4 study for HIV infected patients with HCV genotype 1 or 4, sofosbuvir/ledipasvir for 12 weeks had a 96% HCV cure rate. The study included some very treatment-experienced patients and 20% overall had cirrhosis. The one baseline characteristic predicting treatment failure was black race, many of whom were receiving TDF/FTC/EFV - raising questions about a possible pharmocogenomic issue leading to the interaction. In the ALLY-2 study for HCV (any genotype), sofosbuvir plus daclatasvir for 12 weeks cured 97% of coinfected study subjects, treatment naive or experienced. An 8-week course in treatment naives was less effective (76% cure). The NA-ACCORD analysis of abacavir and cardiovascular risk did not settle the issue of whether the drug leads to increased cardiovascular risk: some of the study’s analyses showed a significant association between abacavir and MI, others did not. Unfortunately in the case of the “Mississippi baby” the child relapsed after 22 months with an undetectable viral load.

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