Title

New paradigms on ART

Code

TUSY04

Session Type

Symposia Session

Venue

Sala A

Date Time

Tuesday 23 July, 14:30 - 16:00

Chair:

Pedro Cahn, Fundación Huésped, Argentina

In this session, the speakers will address new and future ways of delivering of ART and its relevance for PLHIV. The speakers will address: controversies on dual versus triple therapy; how to identify post-treatment controllers; the role of long-acting injectable devices; and approaches to control immune activation

14:30 TUSY0401	Introduction Pedro Cahn, Fundación Huésped, Argentina

14:40 TUSY0402	Dual versus Triple ART, what to use to start? Roy Gulick, Weill Cornell Medicine, United States	Slides

14:55 TUSY0403	Injectables and implanting devices: Pro versus cons? Chloe Orkin, Royal London Hospital - BHIVA, United Kingdom	Slides

15:10 TUSY0404	Therapeutic approaches to control HIV immune activation Michaela Muller-Trutwin, Institut Pasteur, France

15:25 TUSY0405	ART Rapid start, when, why, for whom? Serena Koenig, Brigham and Women's Hospital, United States	Slides

15:40 TUSY0406	Facilitating development of and ensuring future access to innovative drug formulations and delivery mechanisms Charles Gore, Medicines Patent Pool, Switzerland	Slides

15:50 TUSY0407	Closing remarks

AUTHOR

Laura Waters

SUMMARY

Despite excellent ART outcomes, patients rightly want more; new drugs, new strategies & new delivery modes are under investigation. This session summarised past/present/future of 2DR, injectables, immune activation and rapid ART. Innovation limited to resource-rich settings is unacceptable; how access-oriented licensing can support new ART approaches was also addressed.

HIGHLIGHTS

Trip Gulick reviewed 2DR, highlighting value of pilots to inform larger trials. Dolutegravir+3TC & dolutegravir+RPV are the first approved initial/switch 2DR. More 2DR tomorrow including doravirine+islatravir (MK-8591). Chloe Orkin covered injectables/implants including lessons from other fields. ATLAS/FLAIR support IM rilpivirine/cabotegravir; issues include PK tail/drug interactions & poor adherers. Many more agents & delivery modes ahead but addressing issues for ALL is essential. Michaela Muller-Trutwin addressed persistent immune activation on suppressive ART, early ART benefit & challenges of biomarkers. Most anti-inflammatory interventions inconclusive. Serena Koenig promoted same-day ART. If we need a test how to make it easy? TB symptoms drive ineligibility in Africa but clear algorithms markedly improve uptake. Charles Gore ended on treatment access & the role of the Medicines Patent Pool (MPP). TLD supplied by 6 generic companies to 2.7million within 5 years of dolutegravir approval & MPP plans a long-acting technology access hub. Don’t address access last!

CRITICAL ASSESSMENT

Suboptimal strategies may become optimal as components evolve, illustrated by approvals of DTG-based 2DR. Injectables/implants are efficacious & preferred by patients but as long-acting methods evolve issues facing women & children must be addressed at earlier development stages. The lack of impact in most studies of anti-inflammatory interventions highlights our needs to better understand the mechanisms. Same-day ART may be feasible & recommended by WHO for ‘ready’ patients but gaps around longer-term outcomes, and patient preferences, remain. ‘No-one left behind’ must apply also to latest technologies & the MPP provides one mechanism for expanding access to these.