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Conference
"2nd IAS Conference on HIV Pathogenesis and Treatment" Dr. Anita Rachlis (biography) English - 2003-07-28 - 14 minutes
(10 slides)
Summary : Dr Rachlis presents here some highlights from the 2nd IAS Meeting in Paris, focusing on antiretroviral therapy. Several presentations were made looking at treatment simplification and alternative treatment strategies. The ACTG 5095 study will continue to look at the combined arms (TZV/CBV + EFV) to see whether TZV or CBV is superior. Emtricitabine is a once daily alternative for treatment naïve as well as PI-suppressed patients. The once-daily ABC, 3TC, TDF regimen leads to virologic failure with both M184V and K65R mutations. The SWATCH Study showed favourable outcomes in patients who alternated treatment regimens. In salvage therapy, ATV/r was found to be comparable to LPV/r in bringing the viral load<50 in 24 weeks. Also, promising new drugs are coming out such as SPD754, a nucleoside analog that has activity against isolates with most of the common RT mutations, and TMC114, a PI with activity against PI-resistant strains. These and other findings from the 2nd IAS will be discussed in this presentation.
Learning objectives : The participant will learn about some new data on antiretroviral therapy presented at the 2nd IAS Meeting in Paris:
- PI-sparing regimens (Abstract 41): The updated results from the ACTG 5095 study comparing 3 PI-sparing regimens for initial HIV therapy showed that at 48 weeks the viral load <200 was 89% for the combination arms (TZV/CBV + EFV) and 74% for the Trizivir only arm. Viral load <50 was 74% for the combined arms and 61% for the Trizivir only arm. The study will continue to compare the combined arms to determine whether TZV or CBV is superior.
- Simplified regimens: Emtricitabine seems a good once daily alternative for patients previously suppressed on PIs (Abstract 37), and also for treatment naïve patients (Abstract 38).
- Triple-nuc regimens (Abstract 34): A pilot study showed that once-daily ABC with 3TC and TDF leads to virologic failure with both M184V and K65R mutations.
- Nuc-sparing regimens (Abstracts 36 and 39): Preliminary studies suggest these may have benefits and are efficacious yet further controlled studies are required to determine long-term durability of viral suppression and less mitochondrial toxicity.
- Switching ARV regimens (Abstract LB5): Better outcomes (viral loads less than 400) in those patients who were in the alternating (between d4T, ddI, EFV or ZDV, 3TC, NFV) arm.
- Salvage therapy (Abstracts 114, 117, 118): An algorithmic approach was introduced by Dr Schlomo Staszewski (Abstract 114). Unboosted ATV was not as efficacious as LPV/r in failing patients (Abstract 117), and ATV/r was comparable to LPV/r in bringing the viral load to <50 at 24 weeks.
- Entry inhibitor T-20 (Abstract 116): The TORO trials showed that the use of T-20 may be maximized in the case of salvage therapy or treatment failure.
- STI use at treatment failure (Abstract 119): No difference in outcomes found between STI and non-STI groups based on baseline CD4+ count or drug susceptibility.
- New agents (Abstracts LB15, LB16): SPD754 is a nucleoside analog that has activity against isolates with most of the common reverse transcriptase mutations (Abstract LB15). TMC114 is a PI with activity against PI-resistant strains (Abstract LB16).
Bibliographic references : BIKS STUDY(LOPINAVIR|RITONAVIR-EFAVIRENZ COMBINATION): COMPLETE 24-WEEK RESULTS V.Ferré, C.Allavena, I.Poizot-Martin, G.Beck-Wirth, I.Cohen Codar, P.Perré, F.Raffi, and the BIKS study group
Monday, July 14th, 2003 – Session 9OA – Abstract 36
EMTRICITABINE, DIDANOSINE AND EFAVIRENZ ONCE-DAILY (OD) VERSUS CONTINUED PI-BASED HAART (C) IN HIV-INFECTED ADULTS WITH UNDETECTABLE PLASMA HIV-RNA: 48-WEEK RESULTS OF A PROSPECTIVE RANDOMIZED MULTICENTER TRIAL (ALIZE-ANRS 99)
J.M.Molina, F.Ferchal, V.Journot, P.Yéni, W.Rozenbaum, C.Rancinan, L.Morand-Joubert, S.Fournier, P.Morlat, B.Dupont, J.F.Delfraissy, P.Dellamonica, I.Poizot-Martin, E.Rosenthal, G.Chêne, the Alize study group
Monday, July 14th, 2003 – Session 9OA – Abstract 37
A RANDOMIZED, DOUBLE-BLIND, MULTICENTER COMPARISON OF EMTRICITABINE QD TO STAVUDINE BID IN TREATMENT-NAÏVE HIV-INFECTED PATIENTS
F.Raffi, M.Saag, P.Cahn, M.Wolff, D.Pearce, J.M. Molina, J.Hinkle, A.Shaw, E.Mondou, J.B.Quinn, F.Rousseau for the FTC301 Study Team
Monday, July 14th, 2003 – Session 9OA – Abstract 38
COMPARISON OF PI-BOOSTED INDINAVIR WITH EFAVIRENZ+|-STAVUDINE REGIMENS IN EASIER (EUROPEAN AND SOUTH AMERICAN STUDY OF INDINAVIR, EFAVIRENZ, AND RITONAVIR) M.Stek Jr, B.Hirschel, J.Benetucci, G.Reboredo, A.Streinu Cercel, J.Begovac, K.Brinkman, D.Banhegyi, M.Shivaprakash, J.Menten for the EASIER study team
Monday, July 14th, 2003 – Session 9OA – Abstract 39
ACTG 5095: A COMPARATIVE STUDY OF 3 PROTEASE INHIBITOR-SPARING ANTIRETROVIRAL REGIMENS FOR THE INITIAL TREATMENT OF HIV INFECTION.R.M.Gulick, H.J.Ribaudo, C.M.Shikuma, S.Lustgarten, W.A.Meyer, K.Klingman, K.E.Squires, S.Snyder, D.R.Kuritzkes
Monday, July 14th, 2003 – Session 9OA – Abstract 41
INDUCTION OF ANTIRETROVIRAL-NAÏVE HIV-INFECTED SUBJECTS WITH TRIZIVIR (TZV) AND SUSTIVA (efv) FOR 48 WEEKS (ESS40013) M.Markowitz, J.Lang, E.DeJesus, C.Hill-Zabala, E.R.Lanier, Q.Liao, K.Pappa, M.Shaefer
Monday, July 14th, 2003 – Session 9OA – Abstract 42
EARLY VIROLOGIC FAILURE IN A PILOT STUDY EVALUATING THE EFFICACY OF ABACAVIR, LAMIVUDINE AND TENOFOVIR IN THE TREATMENT NAÏVE HIV-INFECTED PATIENTS C.Farthing, H.Khanlou, V.Yeh
Monday, July 14th, 2003 – Session 9OA – Abstract 43
NOVEL STRATEGIES FOR SALVAGE THERAPY
Schlomo Staszewski
Tuesday, July 15th, 2003 – Session 23 – Abstract 114
ANALYSIS OF VIROLOGICAL RESPONSE OF ENFUVIRTIDE IN TORO: IMPLICATIONS FOR PATIENT MANAGEMENT J.Montaner, R.DeMasi, J.Delehanty, J.Chung, Z.Gafoor, M.Salgo, on behalf of the TORO 1 and TORO 2 study group
Tuesday, July 15th, 2003 – Session 23FO – Abstract 116
ANTIVIRAL EFFICACY, METABOLIC CHANGES AND SAFETY OF ATAZANAVIR (ATV) VERSUS LOPINAVIR|RITONAVIR (LPV/RTV) IN COMBINATION WITH 2 NRTIs IN PATIENTS WHO HAVE EXPERIENCED VIROLOGIC FAILURE WITH PRIOR PI-CONTAINING REGIMEN(S): 24-WEEK RESULTS FROM BMS AI424-043 L.Nieto-Cisneros, C.Zala, W.J.Fessel, J.Gonzalez-Garcia, C.Cohen, R.McGovern, E.Adler, C.McLaren
Tuesday, July 15th, 2003 – Session 23FO – Abstract 117
EFFICACY AND SAFETY OF ATAZANAVIR (ATV) WITH RITONAVIR (RTV) OR SAQUINAVIR (SQV)VERSUS LOPINAVIR|RITONAVIR (LPV|RTV) IN COMBINATION WITH TENOFOVIR (TFV) AND ONE NRTI IN PATIENTS WHO HAVE EXPERIENCED VIROLOGIC FAILURE TO MULTIPLE HAART REGIMENS: 16-WEEK RESULTS FROM BMS AI424-045 R.Badaro, E.DeJesus, A.Lazzarin, J.Jemsek, B.Clotet, A.Rightmire, A.Thiry, R.Wilber
Tuesday, July 15th, 2003 – Session 23FO – Abstract 118
FAILURE OF STRUCTURED TREATMENT INTERRUPTION (STI) TO CONFER BENEFIT IN THE SETTING OF TREATMENT FAILURE: CPCRA 064 RESULTS BY BASELINE CD4 COUNT AND PHENOTYPIC SENSITIVITY SCORE (PSS) SUBGROUPS J.Lawrence, K.Huppler Hullsiek, D.Mayers, D.Abrams, R.Reisler, L.Crane, B.Schmetter, T.Dionne, J.Saldanha, M.Jones, J.Baxter, the CPCRA 064 Study Team for the Terry Beirn Community Programs for Clinical Research on AIDSTuesday, July 15th, 2003 – Session 23FO – Abstract 119
ALTERNATION OF ANTIRETROVIRAL DRUG REGIMENS FOR HIV INFECTION: A RANDOMIZED, CONTROLLED TRIAL J.Martinez-Picado, E.Negredo, L.Ruiz, A.Shintani, C.R.Fumaz, C.Zala, P.Domingo, J.Vilaro, J.M.Llibre, P.Viciana, K.Hertogs, C.Boucher, R.T.D’Aquila, B.Clotet and the SWATCH Study Team
Wednesday, July 16th, 2003 – Session 45LB – Abstract LB5
ANTI HIV-1 ACTIVITY OF SPD754 A NEW NRTI: RESULTS OF A 10 DAY MONOTHERAPY STUDY IN TREATMENT NAÎVE HIV PATIENTS P.Cahn, J.Lange, I.Cassetti, J.Sawyer, C.Zala, M.Rolon, R.Bologna, L.Shiveley
Wednesday, July 16th, 2003 – Session 46LB – Abstract LB15
ANTIRETROVIRAL ACTIVITY, SAFETY AND PHARMACOKINETICS OF TMC114, A NEXT-GENERATION HIV-1 PROTEASE INHIBITOR (PI), IN MULTIPLE PI-EXPERIENCED PATIENTS K.Arasteh, N.Clumeck, A.Pozniak, H.Jaeger, M.De Pauw, H.Muller, M.Peeters, R.Hoetelmans, S.De Meyer, W.Parys, R.van der Geest
Wednesday, July 16th, 2003 – Session 46LB – Abstract LB
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