BHIVA Best of CROI Feedback Meetings BHIVA Best of CROI Feedback Meetings 2012

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1 BHIVA Best of CROI Feedback Meetings London North East England North West England Edinburgh Birmingham BHIVA Best of CROI Feedback Meetings 2012 Introduction Simon Collins HIV i-base 1

2 Community perspectives The cure: distant but closer (10+ yrs?) Can PrEP provide >99% protection? Was FEM-PrEP explained by low adherence? ARVs: future once-daily ARV single-pill combinations Complications: reinfection, cardiovascular risk, biomarkers, inflammation (including LPS), HIV and the brain, treatment in primary infection, HCV advances, anal dysplasia and treatment... Cure research 1 Pre-CROI workshop (and IAS) Driven by economic implications of global lifelong treatment: currently <50% coverage Supported by new funding (still <5% of research) and stronger networks of researchers Mapping key questions and approaches: definitions, what to measure, which site, animal models for cure, who to study Timeline is years (10+) at ddc stage? Ethics: risks vs benefits 2

3 Cure research 2 Key approaches Resting T cells (70 yrs to eradicate) - proof of principle with vorinostat Other reservoirs: tissue sites that may not reached by HAART gut (ileum), kidney, lung, brain, other cells - Immune modulation ZFN CCR5 cells (Berlin cure) Other immune approaches Multiple treatment approach PrEP: too effective to be ignored Close to 100% protection at 4-7 doses a week? Access Choice for people at vulnerable times (months/years) i-prex was highly targeted high risk group young gay men, multiple partners with low/intermittent condom use and low disclosure/discussion high use of alcohol/drug (used to taking drugs) and use sex for money or drugs people unable to use condoms (gay or straight) Examples: oral contraceptives, Viagra, statins? 3

4 Future drugs Potential for fixed dose combinations (FDCs) for PI, NNRTI and integrase combinations elvitegravir; dolutegravir; PIs; tenofovir prodrug (GS 7340), generics Will 5-6 single-pill once daily options reduce one of the barriers to early treatment Treatment as Prevention: reducing infectiousness for PEP not to be recommended Funding and costs Quad: Abs 101 and 627; Dolutegravir: abs 102 LB; GS-7340: Abs 103. Complications Reinfection similar as incidence to initial infection? HIV and the brain: longitudinal results from Charter and UK groups, imaging vs testing Cardiovascular risks: CAC, IMT HCV advances Biomarkers, inflammation (including IL-6, d-dimer, LPS) Anal dysplasia and treatment ARV treatment in primary infection 4

5 BHIVA Best of CROI Working Party 2012 Dr D Asboe, Chelsea and Westminster Hospital, London Dr S Bhagani, Royal Free Hospital, London Dr D Churchill, Royal Sussex County Hospital, Brighton Mr S Collins, HIV-iBase Dr S Das, Coventry and Warwickshire Hospital Dr T de Silva, Royal Hallamshire Hospital, Sheffield Dr MJ Fisher, Royal Sussex County Hospital, Brighton Dr J Fox, Guy s and St Thomas NHS Foundation Trust, London Miss E Gathogo, Royal Free Hospital, London D N Kay, Northwick Park Hospital, London Prof S Khoo, University of Liverpool Dr R Kulasegaram, St Thomas Hospital, London Prof C Leen, Western General Hospital, Edinburgh Dr F Martin, University of York Dr G Moyle, Chelsea and Westminster Hospital, London Dr EC Ong, Royal Victoria Infirmary, Newcastle Dr A Palfreeman, Leicester Royal Infirmary Dr S Shaw, Brighton and Sussex University Hospitals NHS Trust Dr C Short, Imperial College London Dr GP Taylor, Imperial College London Dr A Ustianowski, North Manchester General Hospital Miss R Weston, Imperial College London Dr EGL Wilkins, North Manchester General Hospital BHIVA Best of CROI Feedback Meetings London North East England North West England Edinburgh Birmingham BHIVA Best of CROI Feedback Meetings