CROI 2022: Reporting from Margarita/ Breakfast Community Club Session 1

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From Long to Longer: How New ARVs are Rewriting the Script for HIV Prevention and Treatment

 

Speaker: Dr Chloe Orkin

Moderators: Ntando Yolaand, Jim Pickett

Monday 14 February 2022

 

Chloe Orkin has opened the first Margarita/Breakfast Club community meeting with an overview on the latest developments about the new strategies for prevention and treatment being brought to the market. While there are lots of new compounds in the pipeline, the main focus is on combined, long-acting Cabotegravir (CAB) and Rilpivirine (RPV) for treatment, and CAB LA (long acting) for PrEP.

 

CAB+RPV LA, for treatment, can be administered on (up to) a 2 monthly basis, with one injection in each buttock. Though the injections should be administered on a regular basis, if needed it is possible to bridge injections, by taking oral tablets for a short period. This allows for a more flexible and personalized approach. Given the non-inferiority of CAB+RPV LA to the oral therapy, the oral lead in is no longer necessary, as per FDA guidelines. Thigh injections are next in the pipeline as an alternative for people who cannot receive gluteal injections, such as people with silicone implants, or for people who prefer to self-administer their injections.

 

Long-acting CAB+RPV had a 1-1.5% virological failure rate. In terms of safety, there was a low rate of withdrawal due to adverse events (AEs) and 95% of AEs were mild to moderate, most commonly headache, fever and injection site reactions. There were some cases of resistance to both drugs despite perfect adherence, however there are specific factors which make this more likely.

 

Despite the drawbacks, for those who used injections, there was a 9/10 preference rate compared to oral therapy. Healthcare professionals were also satisfied with the implementation of the intervention. Within the CARISEL trial, perceived barriers in implementation (such as staff limitations, appointment issues) were actually found to reduce after 5 months and the majority of people did have their injections. It is important to note however, that for most of the trials for CAB/RPV LA, diversity in participants is still lacking.

 

For Islatravir, there were many promising plans, however currently the studies are on hold or on partial hold, as there were concerns around dose-related immunological issues, such as a mean drop in CD4 cells in treatment studies and a mean drop in total lymphocyte count in PrEP studies.

 

Dr Chloe Orkin highlighted that with the rapidly evolving pipeline, also come trade-offs related to the new opportunities and challenges of emerging treatment and interventions.

 

Click here to watch the recording of the session!

 

 

NEXT MBC, Session #2:

 

Join us for our next Margarita Breakfast Club session on Wednesday 16 February at 7:15 am Mountain/Denver time (15:15 CET) to discuss developments in Cure research.

 

Register here:

https://zoom.us/meeting/register/tJwrdOqhqDMqE9EiX9zOMUgJAPf-h09Twm3v?_x_zm_rtaid=9c9Q1TomTda9dWgHi5gH5A.1644846776297.ad390ff3ad12f17f8937e00e52a0bd17&_x_zm_rhtaid=400

 

More about the MBCs: https://www.eatg.org/events/margarita-breakfast-clubs-at-croi-2022/ 

 

 

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