Marcia Frellick

February 12, 2015

SEATTLE — New research on the treatment and prevention of HIV/AIDS and hepatitis C will dominate the Conference on Retroviruses and Opportunistic Infections (CROI) 2015, which this year adds a special session on Ebola.

There was much media buzz at last year's meeting when it was reported that the Mississippi infant who was born with HIV showed no signs of the virus at the age 3 and was considered to be functionally cured.

"The field was very optimistic about an HIV cure," said David Cooper, MD, from the Kirby Institute at the University of New South Wales in Sydney, Australia.

However, several months later, the virus rebounded in the child.

"I think we realize now that even after very early treatment, the reservoir is still established and can reignite later when treatment is stopped, albeit with a smaller reservoir," Dr Cooper told Medscape Medical News. "I think the field is moving toward the notion of providing long-term control without antiretroviral therapy."

This year, he will outline the historic trajectory of antiretroviral therapy and discuss the Strategies for Management of Anti-HIV Therapy, or SMART trial, and the Strategic Timing of Antiretroviral Treatment, or START trial.

Dr Cooper said he will paint the future for rolling out antiretrovirals globally, "given the absence of a vaccine or cure in the foreseeable future."

High-Priced Hepatitis C Cure Rates

Despite the high cure rates of hepatitis C with new interferon-free drugs, Arthur Kim, MD, director of the viral hepatitis clinic at Massachusetts General Hospital in Boston, will explain why work still needs to be done.

"In an era when we can treat most individuals with over 90% success rates, there's a sense that hepatitis C is a solved problem," he said. However, because of the cost of the antiviral regimens, "treating everyone with hepatitis C is not feasible in the short term."

Identifying hepatitis C is essential, especially considering the increase in high-risk behaviors, such as opiate abuse and intravenous exposures, he explained.

At the meeting, Dr Kim will also talk about why genotype 3 is the next target for treatment.

"The currently recommended regimen is 24 weeks of sofosbuvir plus ribavirin in the United States, which is quite pricey. Therefore, there's a need for better treatment options for genotype 3 that parallel those developed for genotypes 1 and 4. There is hope for novel therapies that have yet to be approved for genotype 3, including daclatasvir," he said.

Preexposure Prophylaxis Gaining Momentum

Damon Jacobs, LMFT, a marriage and family therapist in New York City, is part of a team presenting community approaches to slow the spread of HIV and AIDS. His presentation will center on preexposure prophylaxis.

In 2013, he realized that little information about preexposure prophylaxis was available in New York City, so he started a Facebook page (access must be requested) that is monitored by professionals to ensure only the science-supported information is posted. The group now has more than 5300 members worldwide.

"It was the first place in social media that people could come to learn the science, the data, the facts, ask questions, and state opinions," Jacobs told Medscape Medical News.

"We give them the resources, the tools, and the CDC documents they need to take with them to their first doctor's appointment." The page answers questions such as how to find a provider nearby and how to navigate insurance, and deals with concerns about stigma and adverse effects. Members also discuss the latest research.

Jacobs said he is particularly interested in presentations on the French IPERGAY study, which looks at whether on-demand prophylaxis is a viable alternative to daily dosing, and the British PROUD study, which looks at the effect of treatment on sexual behavior.

Ebola Session Added

Although most of the meeting agenda centers on HIV and hepatitis C, organizers have added a session on Ebola.

Gilles Van Cutsem, MD, will present the Médecins Sans Frontières experience with current outbreaks.

Clifford Lane, MD, deputy director of clinical research and special projects at the National Institute of Allergy and Infectious Disease, told Medscape Medical News that his presentation will focus on the best approaches to standard of care, which investigational agents might be valuable in treatment or prevention, and the long-term sequelae of infection in those who survive.

Dr Cooper, Dr Lane, and Mr Jacobs have disclosed no relevant financial relationships. Dr Kim reports serving on scientific advisory boards for Bristol-Myers Squibb and AbbVie Pharmaceuticals. His institution, Massachusetts General, has received research support from Gilead Sciences and Abbvie Pharmaceuticals.


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