EACS 2019 Preview

EACS 2019: Integrating New Data and Guidance Into Optimal HIV Care

Released: October 30, 2019

Expiration: October 28, 2020

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The biannual European AIDS Conference (EACS) is a key venue for clinicians to learn about the latest developments in HIV management. At the 2019 conference held in Basel, Switzerland, I look forward to informative discussions regarding the release of new EACS guidelines on the treatment of HIV-positive adults in Europe, ARVs newly available in Western European markets, and important data on HIV care in women. Presentations on these issues promise to improve the care of our patients with HIV and will help clinicians to select the optimal ART regimen for each patient.

To aid clinicians in selecting treatments using the best available data and guidance, I have worked with Clinical Care Options and my colleagues José R. Arribas, MD; Alexandra Calmy, MD, FMH, PhD; and Laura Waters, MD, to develop a complimentary, case-based, CME-certified symposium with live simulcast presented during EACS 2019. Our discussion will center around how newer ARV regimens approved for use in the last year or so fit into current HIV practice, both for treatment-naive patients and in the switch setting. I highlight below some of the clinical challenges and controversies that we face in contemporary practice, many of which our expert faculty panel will discuss.

Dual Therapy
Emerging data support dual therapy as a safe, effective option. When and how should clinicians decide among the 3 main dual therapies, dolutegravir (DTG) plus rilpivirine (RPV), DTG plus lamivudine (3TC), or a boosted PI plus 3TC? Which are approved and recommended in first-line settings, as switch strategies for patients with virologic suppression, or both?

Second-Generation INSTIs
With bictegravir (BIC) now approved, how do we decide between recommending BIC and DTG? INSTI selection has become more complex as postapproval data suggest novel toxicities associated with this class, notably a small but elevated risk of neural tube defects with periconception DTG exposure and, among patients receiving INSTI-based ART, increased weight gain and a potential risk of neurologic events. Furthermore, we must look to postapproval data to better understand the risk of emergence of resistance with these agents.

Tenofovir Alafenamide (TAF) vs Tenofovir Disoproxil Fumarate (TDF)
A common argument supporting continued use of TDF is its cost-effectiveness compared with TAF, whereas the use of TAF is generally supported by its improved renal and bone safety profiles compared with TDF. Should TAF replace TDF in routine practice, or are there still situations in which clinical factors other than cost support using TDF?

Doravirine (DOR)
In November 2018, the European Medicines Agency approved a new NNRTI, DOR, as part of the single-tablet regimen (STR) DOR/3TC/TDF or in combination with other ARVs for adults with HIV-1 infection and no evidence of resistance to NNRTIs. How do we—or should we—integrate this novel agent into care? What are the limitations of our current data on DOR?

Boosted PIs
With the availability of INSTIs and novel ARV classes, clinical management seems to be moving away from regimens based on boosted PIs. When should clinicians consider using a boosted PI, and is there a future for this class?

Generics
Generic ARVs can improve affordability but can also preclude the use of STRs and newer agents. How do clinicians balance these competing issues, and what are the effects on patients?

Join Us!
If you want to hear more on these and other pressing clinical issues, such as the rationale behind changes in the forthcoming EACS guidelines, please join us in person at the conference or stream the symposium online on Friday, November 8, 2019.

Going to Basel? To register for the live symposium, please click here.

Viewing from home? To register for the virtual simulcast, please click here.

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Poll

1.

Which of these management decisions poses the greatest challenge in your HIV practice?

A. Deciding between dual and triple therapy
B. Selecting among available INSTIs
C. Deciding between TAF and TDF
D. Integrating DOR into care
E. Incorporating new ART guidance into care
F. Something else (please leave a comment)

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