slide1
Download
Skip this Video
Download Presentation
ARV and ART: looking to the future

Loading in 2 Seconds...

play fullscreen
1 / 21

ARV and ART: looking to the future - PowerPoint PPT Presentation


  • 102 Views
  • Uploaded on

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' ARV and ART: looking to the future' - calix


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

ARVs and ART – looking to the futureSharon R LewinProfessor and Head, Department of Infectious Diseases, Monash University and Alfred HospitalCo-head, Centre for Biomedical Research, Burnet Institute, Melbourne, Australia 7th IAS Conference on Pathogenesis, Treatment and Prevention, Kuala Lumpur, 30th June – 3rd July, 2013

arv and art looking to the future
ARV and ART: looking to the future
  • Better antiretrovirals
    • Reduce cost
    • Reduce toxicity
    • Enhance durability of control
  • Reduce long term morbidity
  • The very distant future
strategies to reduce cost of current arvs
Strategies to reduce cost of current ARVs
  • Optimising the active pharmaceutical ingredient (API)
    • Optimise material sourcing
    • Change in manufacturing process
    • Improve bioavailability
  • Pharmaco-enhancement
  • Extension of shelf-life
  • Reduce dose

Crawford et al., Lancet Infect Dis 2012; 12:550; Conference on Antiretroviral Dose Optimisation (CADO), 2010

new source of raw material mg tert butoxide reduces cost of tdf
New source of raw material Mg tert-butoxide reduces cost of TDF

Similar strategies currently being evaluated for

efavirenz, ATZ/r, DRV/r

Crawford et al., Lancet Infect Dis 2012; 12:550

new arvs in development
New ARVs in development

Gulick, 20th CROI, Atlanta, GA, March 2013

tenofovir alenofenamide taf reduced renal toxicity and cost

100

90

80

70

60

50

% HIV-1 RNA <50 c/mL

40

30

20

10

0

16

24

2

12

4

8

Time (Weeks)

  • TAF/FTC/EVG/COBI
Tenofovir alenofenamide (TAF): reduced renal toxicity and cost

TDF/FTC/EVG/c 90% (n=58)

TAF/FTC/EVG/c 88% (n=112)

  • Change in serum creatinine at Week 24
    • TAF +0.07 mg/dL
    • TDF +0.12 mg/dL (p=0.02)

Rx-naïve, VL >5000, CD4 >50 (N=170)

new technologies for delivery of arvs
New technologies for delivery of ARVs
  • Nanotechnology
    • Efavirenz 300mg
    • Pediatric LPV/r in development
  • Injectables, implants, slow release
    • GSK744 + rilpivarine LA
    • GSK744 + 2NRTI (Latte study)
    • Vaginal rings e.g., dapivirine / maraviroc
  • Multipurpose prevention technologies
    • HIV + STI + pregnancy
long and short term priorities to improve arvs
Long and short term priorities to improve ARVs
  • First-line
    • fixed-dose combination regimens that are equally or more potent and more durable and affordable than TDF/XTC/EFV
  • Post Treatment –failure
    • fixed dose boosted, dose-optimized darunavir in replacing atazanavir or lopinavir as the protease inhibitor of choice
    • A one pill once daily second-line regimen.
    • Studies of reduced-dose darunavir/ritonavir (DRV/r),
  • Enhancing Trial Participant Criteria
    • including girls and women of reproductive age, TB co-infection, and comorbidities (such as hypertension).
  • Longer Term Research Priorities
    • oral and injectable long-acting drugs (including GSK744 and TMC278) as well as nano-formulations and implantable devices.

CADO2 report, South Africa, April 2013

increased age related complications on art
Increased age-related complications on ART

Mean AMI events per

1000 person years

Increased risk of AMI in HIV compared to HIV uninfected

HR = 1.48 (CI = 1.27 – 1.72)

Further increase HR if CD4<200 or HIV RNA>500

N=82,459; Veterans Ageing Cohort Study Virtual Cohort

Frieberg et al., JAMA Internal Med 2013

hiv and aging in africa
HIV and aging in Africa

In 2040, the number of persons over 50 years of age

living with HIV is expected to be 9 million

Mills et al., N Engl J Med 2012; 366:14

etiology of non aids related events
Etiology of non-AIDS-related events

cART

toxicity

Non-AIDS

events

Lifestyle

Persistent

inflammation(immune activation)

(e.g. smoking)

Non-AIDS-related events are more common in HIV disease, even after adjustment for age, cART exposure and traditional risk factors

Deeks SG, Phillips AN.Br Med J 2009;338:a3172

prevention of non aids events needs a different model of care
Prevention of non AIDS events needs a different model of care
  • Lifestyle modifications
    • Reduce smoking, healthy diet, exercise
  • Reduce modifiable risk factors
    • Assessment of blood pressure, glucose and lipids
  • Counselling and screening for common cancers
  • Enhance CD4 recovery and reduce inflammation
hiv cure is rare and possible but a very long term goal
HIV cure is rare and possible – but a very long term goal

The Berlin Patient

THE VISCONTI PATIENTS

The Mississippi baby

acknowledgements
Acknowledgements

The Alfred Hospital, Melbourne

Julian Elliott

Jennifer Hoy

Edwina Wright

Elsewhere

Steve Deeks

Diane Havlir

Trip Gulich

Judith Currier

Andrew Ball

Adeeba Kamarulzaman

ad