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EACS 2023 Latin America
Latin America: New HIV Data From EACS 2023

Released: November 08, 2023

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Key Takeaways
  • Switching to BIC/FTC/TAF among those in Mexico showed that virologic control can be maintained with considerable tolerability.
  • People living with HIV reported high satisfaction with initial treatment or switch to BIC/FTC/TAF in Argentina.
  • Dual therapy with DTG/3TC among patients in Brazil is a valid switch strategy.

Among the interesting data presented at EACS 2023, held October 18-21 in Warsaw, Poland, I selected a handful of studies that were led by researchers from and affect clinical practice in Latin America, many of which were real-world studies.

Switching to BIC/FTC/TAF in Mexican Clinical Practice
A retrospective study was performed in northern Mexico using an electronic database to collect data from August 2019 to August 2020. In total, 886 persons living with HIV were included, with 77% being male and 100% with virologic control.

Researchers analyzed the result of switching patients from their first antiretroviral therapy regimen that was no longer ideal to bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF). Patient data were reviewed 12 months after the switch, and 99% maintained virologic control.

Only 7% reported mild to moderate adverse events, with the most common being headache and diarrhea. There were no discontinuations due to these adverse events or weight gain.

Researchers concluded that, in this real-world retrospective study, switching to BIC/FTC/TAF in persons living with HIV who are already in virologic control can maintain that control with considerable tolerability. 

Analyzing Metabolic Profile and Renal Function in Argentine Clinical Practice 
Researchers from Argentina presented data on the metabolic profile and renal function of persons living with HIV receiving fixed-dose combination BIC/FTC/TAF. This was an observational retrospective cohort study that included 2356 treatment-experienced and 315 treatment-naive patients.

The study compared fasting glucose, total cholesterol, high-density and low-density lipoprotein cholesterol, and estimated glomerular filtration rate from baseline to 24- and 48-week follow-up.

No significant differences were observed at 24 and 48 weeks among these parameters, except for a decrease in triglycerides in the treatment-experienced cohort. Mild increases were reported in median values from baseline to 48-week follow-up for total cholesterol and high-density lipoprotein cholesterol among the treatment-naive cohort. Mild decreases also were reported in estimated glomerular filtration rate at 24- and 48-week follow-up in both cohorts.

Researchers concluded that these real-world data support the safety and metabolic profile of fixed-dose BIC/FTC/TAF therapy for people living with HIV.

Understanding Patient-Reported Outcomes in Argentine Clinical Practice
In analyzing patient-reported outcomes of people living with HIV in Latin America receiving BIC/FTC/TAF, this cross-sectional study assessed quality of life, treatment satisfaction, symptom perception, and psychological and social factors via validated instruments. An electronic survey was administered to 1500 people, with 536 (36%) returning a response. In total, 72% were male, and the median age was 48 years. Furthermore, 65% of respondents received BIC/FTC/TAF for at least 1 year.

Of note, 92% reported no medication concerns. The median quality of life score was 89 vs 88 for BIC/FTC/TAF as first-line treatment vs switching, respectively. In addition, 88% reported an absence of worry regarding weight or muscular mass loss, and 62% reported an absence of worry regarding weight gain or fat accumulation.

This real-world study shows that patient satisfaction is high among those living with HIV receiving a single-tablet regimen of BIC/FTC/TAF.

Using Dual Therapy in Brazilian Clinical Practice
Researchers from Brazil presented a retrospective analysis of persons living with HIV/AIDS, looking at those receiving dual therapy—dolutegravir 50 mg plus lamivudine 300 mg—for 1 year. The data for this review were collected from patients’ health records and an antiretroviral dispensing system.

In total, 383 eligible patients were included, with 76% being cisgender men and a median age of 56.9 years. Reasons for using dual therapy were bone or kidney comorbidity and convenience.

After 1 year, 371 patients (97%) still were receiving dual therapy, and 8 patients (2%) switched for various reasons. This real-world retrospective study confirms dual therapy as a valid switch strategy, where indicated, for persons living with HIV.

ANDES Trial in Argentina
Data from a substudy of the randomized ANDES trial were presented at EACS 2023. This clinical trial evaluated viral reservoirs in people living with HIV receiving dual therapy, comparing the 2-drug regimen of coformulated darunavir/ritonavir 800/100 mg plus lamivudine 300 mg vs the 3-drug regimen of the same darunavir/ritonavir dose plus lamivudine/tenofovir 300/300 mg.

In total, 32 patients were enrolled, with 14 receiving the 2-drug regimen and 18 receiving the 3-drug regimen. Researchers measured total and integrated HIV DNA, along with unspliced RNA, using real-time polymerase chain reaction tests. In addition, enzyme-linked immunosorbent assay was used to quantify soluble markers.

At 48-week follow-up, all patients achieved a plasma HIV-1 RNA below 40 copies/mL, and no significant differences were reported between the patient groups.

To me, studies like these give additional evidence to the already demonstrated potency of dual-therapy regimens in treating persons living with HIV.

Your Thoughts?
Which of the above studies will most affect your clinical practice? See more studies from IDWeek and EACS 2023, and get involved by posting a comment below.