July 29th, 2018

Really Rapid Review — International AIDS Conference 2018, Amsterdam

The International AIDS Conference — or “AIDS 2018” — returned to Amsterdam for the first time since 1992.

It’s worth pausing, with gratitude, to remember that 26 years ago antiretroviral therapy consisted of three available drugs — zidovudine (AZT), didanosine (ddI), and zalcitabine (ddC).

All were marginally effective, with limited durability and significant toxicity. In fact, the big debate in the early 1990s was whether treatment of HIV before symptom onset was worthwhile at all.

We had no NNRTIs, PIs, or integrase inhibitors. Aside from recommending condom use and abstinence, we had no strategies to prevent HIV among sexually active adults.

Fast-forward to today, where the goal is to have everyone with HIV on treatment for both their individual benefit and to end the epidemic.

Gratitude indeed!

Here are some highlights from the meeting which took place last week, a Really Rapid Review© of important (or just interesting) studies that caught my eye. Apologies ahead of time for missing your favorite — as always, let me know in the comments section what I missed!

Amsterdam remains a gem, a marvelous city with distinctive architecture, great food, nice people, picturesque canals, and incredible museums. It was even better than the last time I was here — seemed cleaner, bustling but less congested (at least with car traffic), and decidedly less seedy. The fact that it was unbelievably hot didn’t deter many of us (including me) from biking around town, joining the throngs who regularly take advantage of the flat terrain and the extensive bike lanes.

But visitors beware — when it’s time to go home, the airport is a chaotic, crowded mess. The warnings to arrive 3 hours before departure time should not be taken lightly. I’d call the airport a zoo, but that might be insulting to some zoos!

Poor Melanie! Hartsfield will seem downright peaceful by comparison.

Next year’s meeting will be in Mexico City, July 21-24, 2019. It too is a wonderful, vibrant city (and where I’ve had some of the best restaurant meals in my life) — but based on the traffic the last time we were there, bike transport seems highly unlikely!

So what did I miss?

9 Responses to “Really Rapid Review — International AIDS Conference 2018, Amsterdam”

  1. Sébastien Poulin says:

    Excellent review thank you Dr Sax !

    I would add :

    1-
    A Phase 3b Open-Label Pilot Study to Evaluate Switching to Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (E/C/F/TAF) Single-Tablet Regimen in Virologically-Suppressed HIV-1 Infected Adults Harboring the NRTI Resistance Mutation M184V and/or M184I
    (GS-US-292-1824): Week 24 Results

    Early (24 weeks) and very small (n=37) but ongoing….

    2-
    Genotype at HIV diagnosis: no longer cost-effective in the INSTI treatment era?

    Basic debating skills required to discuss it with colleagues 😉

    • Paul Sax says:

      Agree! #2 has now been added, with a disclosure here that I am very closely involved with this analysis …

      Paul

  2. Brenda Crabtree says:

    Thank you for your fantastic review!
    I’d add a few lines about Dr. Malebranche in terms of stopping stigmatizing language in health care settings: better not use “retained in care” but instead “engaged to care”, better not call “people hard to reach” and instead, try understand better why they dont return to care… as health care providers, we have to put close attention to all our “costumers” needs and be better.
    Thank you for the last comment about muy beautiful and chaotic City, it is very much appreciated. We will be very happy to welcome you all in 2019

  3. Ezequiel Córdova says:

    Excellent review!. Another interesting study is that presented by C. James et al. who reported an increased risk of virological failure in patients receiving integrase inhibitors and polyvalent cations like zinc, iron and calcium and multivitamin products containing these cations.

  4. Scott Dryden-Peterson says:

    Wonderful Paul, thank you!

    The large Ya Tsie and SEARCH trials of the test and treat strategy should be considered for inclusion. These are likely among the most important studies presented for the global response, including high income settings (caveat, I am an investigator in Ya Tsie).

    The Ya Tsie Trial provides the first randomized evidence that a test and treat strategy can reduce population HIV incidence (and perhaps first evidence of any intervention on population incidence). Reduction was modest ~35% (borderline statistical significance), perhaps due existing high ART coverage and baseline HIV testing in control arm pushed further (staggering 82% of ALL PLWH will suppressed viral load).

    The intervention in the SEARCH trial in Uganda and Kenya, annual multi-disease fairs and rapid ART initiation, did not reduce HIV incidence but did reduce untreated HIV, incident TB, hypertension, and mortality. Similar to Ya Tsie, baseline HIV testing in the control communities likely increased ART use and contributed to decreased HIV incidence in both intervention and control communities.

    Both trials also highlighted ongoing challenges with timely and regular HIV testing in the young and among asymptomatic men.

  5. Most people don’t even know what the Stonewall Riots were, much less what ACT UP is or that Aids is not “over”, so, HUGE thanks

  6. Philip Bolduc says:

    Thanks for this great review, Paul. One small item: while DCF-TAF may not require HBV testing, I like to know not only if I’m co-treating chronic HBV with the TAF but also what the ALT, eAg, eAb and VL are prior to initiation of therapy so that I can determine their pre-treatment HBV stage.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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