From Fat to Fit

Earlier this year, the International AIDS Society’s 2017 Conference on HIV Science in Paris provided numerous new insights into HIV-related treatment. The three-day annual conference focused on scientific advancements made in treatment and prevention of the virus. Here’s a round-up of the top findings.

Can Egrifta Also Make You Buff? Egrifta (tesamorelin) may not only reduce fat deposits but could also build muscle as well. Analysis of data from two randomized placebo-controlled trials of Egrifta among HIV-positive people with lipodystrophy — a redistribution of fat that impacts up to 50 percent of those living with HIV and is responsible for wasting, buffalo humps, and other fat changes — showed that, as fat in trunk muscles decreased, muscle area increased. In the study participants not only lost excess visceral adipose tissue (a.k.a. abdominal fat) when taking the drug from Theratechnologies, they also saw muscle growth. The amount of muscle growth wasn’t tied to the amount of abdominal fat lost.

“This is the first study to evaluate changes in trunk muscle fat — both abdominal and spine musculature — in HIV patients who have responded to tesamorelin,” said Kristine Erlandson, assistant professor of medicine, Divisions of Infectious Disease and Geriatric Medicine, University of Colorado.

More Evidence New Drugs Are Better Than Tivicay Two Phase III studies (1489 and 1490) by Gilead Sciences continue to support substituting bictegravir-based regimens for commonly prescribed dolutegravir-based regimens. Though dolutegravir (Tivicay) is effective, it has been vulnerable to the development of drug resistance, while bictegravir (a new investigational drug of the integrase inhibitor class) appears to avoid that issue. According to Dr. Joseph Custodio from Gilead, bictegravir is less likely to become drug resistant, is useful in treating both non-mutated and drug-resistant HIV, and has low risk of drug interactions.

The new studies concluded that the bictegravir containing regimen is as effective as regimens containing dolutegravir, and has “low rates of discontinuations due to adverse events, a high barrier to resistance and few drug interactions,” according to Dr. Joel Gallant, medical director of specialty services at Southwest CARE Center in Santa Fe, N.M. and lead author of Study 1489.

Dr. Paul Sax, professor of medicine at Harvard Medical School and lead author of Study 1490 said the meds will “be appropriate for a broad range of HIV patients, including those with mild to moderate renal impairment (kidney damage).”

Forthcoming Drug Successfully Treats Multidrug Resistance Given concerns about drug resistance, the Phase II data for ibalizumab was welcome news. The long-acting antibody from Theratechnologies has already been submitted to the Food and Drug Administration for approval (under the fast-track Biologics License Application program).

Ibalizumab continues to prove effective in treating HIV strains resistant to other antiretroviral drugs, a problem for many long-term survivors. In other words, ibalizumab is effective even for those with multidrug resistances, a great advantage to people who’ve developed resistance to multiple classes of anti-HIV drugs, including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors (as well as those resistant to enfuvirtide or maraviroc).

“HIV drug resistance is a key topic at the IAS conference this year, and these findings are particularly important as they suggest that ibalizumab is equally active against HIV, whether it is resistant or responsive to approved antiretroviral agents,” said Steve Weinheimer, vice president of biological sciences at TaiMed Biologics USA, which is collaborating with Theratechnologies to distribute the drug. “On the heels of the BLA acceptance for priority review, these data provide additional support for ibalizumab as a potential tool for the treatment of multidrug resistant HIV-1.”

Researchers Fear a New HIV Pandemic The threat of a new worldwide AIDS pandemic was a frequent topic at the conference, with a sober evaluation of the current epidemic and grim predictions that — if certain conditions remain unchanged — the global fight against HIV could be facing disaster. The depressing reality? We may go from closing in on “the end of AIDS” to a new global pandemic. Core issues that experts say could cause a massive second wave of AIDS-related deaths are:

Drug-Resistance: Many HIV strains are drug-resistant. The longer people are on treatment, the more likely drug resistance will develop. In some countries, as much as 10 percent of the people who start treatment are already resistant to entire classes of treatment.

Manufacturing Limits: Paul Stoffels, the chief scientific officer for Johnson & Johnson, warns that the world’s manufacturers simply cannot sustain 40 or 50 years of manufacturing enough anti-HIV drugs to keep the tens of millions of people living with the virus alive for their lifetimes.