CROI 2019: advances in antiretroviral therapy

Top Antivir Med. 2019 Apr;27(1):50-68.

Abstract

The 2019 Conference on Retroviruses and Opportunistic Infections included many exciting advances in antiretroviral therapy (ART). Investigators presented a case report of a second patient possibly cured of HIV through an allogeneic hematopoietic stem cell transplant from a CC chemokine receptor 5-delta 32 donor. Two clinical trials of long-acting injectable cabotegravir and rilpivirine showed promising safety, efficacy, and tolerability as maintenance ART. Test-and-treat and rapid-ART-start strategies show promise in advancing progress toward the HIV care cascade 90-90-90 Joint United Nations Programme on HIV/AIDS/World Health Organization targets. However, late diagnosis and mortality after ART initiation remain high, even in the context of HIV service scale-up, and mortality from unintentional opioid overdose in people living with HIV in the United States is on the rise. In vitro studies were presented that identified and evaluated the effect of resistance-associated mutations on ART susceptibility and elucidated mechanisms of resistance. Epidemiologic data were reported on the prevalence, impact, regional variation, and changes over time of resistance-associated mutations. Decreasing regional and national rates of resistance may be a benefit of increasing use of integrase strand transfer inhibitors (InSTIs). New findings were presented on maternal and fetal health outcomes in women of reproductive potential, drug-drug interactions between hormonal contraception and ART, and further exploration of the association between InSTIs and birth defects.

Publication types

  • Review

MeSH terms

  • Anti-Retroviral Agents / pharmacokinetics
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • Continuity of Patient Care
  • Contraceptives, Oral, Hormonal / pharmacokinetics
  • Contraceptives, Oral, Hormonal / pharmacology
  • Disease Management
  • Drug Interactions
  • Drug Resistance, Viral
  • HIV / drug effects
  • HIV / genetics
  • HIV Infections / diagnosis
  • HIV Infections / therapy*
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Mutation
  • Treatment Outcome
  • United States

Substances

  • Anti-Retroviral Agents
  • Contraceptives, Oral, Hormonal