Takeaways from CROI 2019: Part 1


From the London Patient to the DISCOVER trial and everything in between, HIV experts provide their biggest takeaways from CROI 2019.

We sat down with several HIV experts to learn more about their research and asked them to share what they’re taking home from CROI 2019. Here's what they said:

Interview transcript (modified slightly for readability):

Brad Hare, MD: CROI is always one of my favorite conferences there's always a lot of new things and it takes a long time to digest all of the science that's shared here. I think folks are certainly very excited about PrEP. So, PrEP is one of the hot areas in the HIV field right now and we're learning more about new ways to deliver PrEP, new drugs to treat prevent HIV for people, and new ways to implement PrEP. So, I'm really most excited to see some of that prevention work translated to those of us on the frontlines and that we can have more options to offer for our patients.

Ava Avalos, MD: I think the highlight of the conference for me was attending one day of the women's pre-conference. It was a really incredible thing to be sitting with so many women and talking about really the effects of ART treatment and how to improve ART treatment for women it was really exciting.

Karin Bosh, PhD: So, this is my first time actually attending CROI, so I think the biggest highlight is just being with so many great researchers and hearing especially the international perspective.

Brian Woodfall, MD: So, CROI is drawing to a close but I think some of the most interesting things are the continued advancement of chronic treatment, including long-acting injectables and new areas — prevention, new data on PrEP and as well the potential for prevention looking forward to other modalities including preventive vaccines.

Kristine Erlandson, MD, MS: So, I think there are several poster talks or oral poster presentations on some of the unintended consequences that we might be seen with integrase inhibitors. So, there’s a session on the weight effects of integrase inhibitors as well as a session on the neurocognitive effects of integrase inhibitors that I'm really curious to hear about.

Certainly, the cure patient is probably a lot of the excitement, and it's hard not to be excited about the potential for another cure, but I think just understanding a little bit more about some of the unintended consequences we might see with antiretroviral therapy, trying to understand whether or not that's an effect of the drug or whether or not it's an effect of HIV, and then what can we do to intervene and prevent some of those, I think is the biggest takeaway for me from a comorbidities/aging standpoint.

Laura Waters, MD, FRCP: The biggest takeaway from CROI 2019 — goodness that's a challenging one because I've seen a whole wealth of data. My attention has been captured by posters I didn't think I'd be particularly interested in. I think the injectables [are] obviously a big story. I think DISCOVER as shown that TAF/FTC is as efficacious as TDF/FTC is really important data; I didn't think it would be as good. In the same session, we saw data showing much lower rectal drug concentrations for TAF than TDF – I didn't think it would work, I was very surprised and it's good to see that it does.

I think a big take-home message for me has been that weight gain is important; it's being studied, it's an important side effect for patients. I think we're learning that the modern integrase inhibitors and also perhaps TAF, are associated and, for me, it means that we're going to be that much more robust about collecting weight in our clinic cohorts and we can start following this up properly.

Jean-Michel Molina, MD: I think we’ve learned that it’s possible to cure HIV. We've seen the second case of an individual with HIV infection and lymphoma, who was maybe not cured but with prolonged remission, potentially cured. So, I think we've learned that is feasible; it's on the horizon. At the same time, we've learned that new drugs, if I may call them drugs, like broadly neutralizing antibodies, are potential tools that we may use in addition with other tools in the future to be able to achieve these potential remissions, so that's a very important area to continue research to try to cure people with HIV infection.

At the same time, we need to improve the tools we have for prevention. We've learned at the conference there are very interesting data on new drugs for prevention. We have had the results of the large DISCOVER study that confirms the PrEP works very well, with very few failures in people taking the drugs. So, that's quite reassuring that, actually, with better tools to prevent HIV infection, better drugs, and potentially hope that in future we could hopefully cure people with HIV infection. So, that quite reassuring and I think now the challenge is how are we going to implement these advances for the benefit of people.

Kavita Misra, PhD, MPH: CROI is a big conference with a lot of new exciting work. Certainly, the very newsworthy story of the second person who was considered cured has been really exciting. The plenary session that talked about the use of antibodies and in treatment research. Our agency is very involved now and using molecular HIV surveillance very aggressively, so this morning's plenary by Alexandra Oster, MD, on the importance of cluster detection using the tools of genetics and molecular HIV surveillance has been very, very timely and I think those are the 2 biggest take homes to me.

Check out part 2 here.

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