World AIDS Day-focusing on long-term plan for AIDS prevention and treatment

December 1, 2021, the 34th "World AIDS Day". This years theme is "life first, ending AIDS and health equality". AIDS needs lifelong treatment. Long term treatment has become the trend of AIDS treatment in the future. On the occasion of World AIDS Day, lets take a look back at the progress of the long term program in the past year on AIDS treatment and prevention.

In January 2021, the US Food and Drug Administration (FDA) approved the first long-acting antiretroviral drug cabenuva (cabotegravir/ripivirine) for injection to treat adult HIV-1 infection. Patients only need to receive treatment once a month to achieve the effect of virus inhibition. The drug can replace the current antiretroviral therapy for patients who have reached the state of virological inhibition after stable antiretroviral treatment, have no known or suspected drug resistance to cabotevir or lipibilin, and have no history of treatment failure. In addition, FDA also approved the tablet formulation of cabotevir, vocabria, for oral use with rilpivirine for one month before receiving cabenuva treatment, so as to ensure good tolerance before switching from tablet to sustained-release injection formulation.

A phase I safety study published at the 2021 retrovirus and opportunistic infection Conference (cRIO) showed that islatravir implantation can prevent HIV for up to one year. Among the three doses of islatravir (48mg, 52mg and 56mg), the active drug concentration reached by the implant at 12 weeks was higher than the predetermined PK threshold; It is expected that at a dose of 56 mg, the implant can provide a drug concentration higher than the predetermined PK threshold for up to one year.

The implant was placed on the patients upper arm and remained in place for 12 weeks. Side effects include redness, pain, tenderness and itching at the implant site. Islatravir is an efficient nucleoside reverse transcriptase translocation inhibitor of human immunodeficiency virus type 1 (HIV-1). It has a long intracellular half-life and is being developed for the prevention and treatment of HIV-1.

Another long-acting preparation, lenacapavir, showed its inhibitory effect on HIV patients with multidrug resistance in a study published at the cRIO meeting.

The study found that 88% of subjects treated with lenacapavir (n = 21/24) had at least 0.5 log10 reduction in HIV-1 viral load at the end of 14 days of functional monotherapy, compared with 17% in the placebo group (n = 2/12). In fact, 72% of patients treated with lenacapavir achieved virus inhibition. All patients reported adverse events during the trial, the most common being headache, nausea, cough, diarrhea and rash, but none led to the suspension of the study. 

The WHO analysis data on more than 15000 HIV carriers in Asia, Europe and Africa presented at the IAS meeting showed that HIV was an independent risk factor for severe or critical diseases of covid-19. HIV infection is associated with higher in-hospital mortality even after adjusting for age, gender and comorbidity progression. The study stressed the importance of including all people living with HIV in the list of priority groups of the national covid-19 vaccination project.

The U.S. Centers for Disease Control and Prevention (CDC) lists HIV as a risk factor for severe covid and recommends that advanced or untreated HIV infected persons receive the third dose of mRNA covid-19 vaccine at least 28 days after the two doses of primary vaccine.

 

 

Cindy