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HIV Glasgow 2024 Highlights for Canada
Advancing HIV Care in Canada: Highlights From HIV Glasgow 2024

Released: November 27, 2024

Expiration: November 26, 2025

Alexander Wong
Alexander Wong, MD, FRCPC
Activity Information

Activity

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Key Takeaways
  • Results of clinical trials presented at HIV Glasgow 2024, such as BICSTaR and DOLCE, highlight the safety, efficacy, and durability of regimens like BIC/FTC/TAF and DTG/3TC, including patients with low baseline CD4+ cell counts.
  • Long-acting injectable options, like cabotegravir and lenacapavir, show promising results for improving HIV prevention outcomes, with strong support in Canadian public funding settings.

The prevailing theme at HIV Glasgow 2024 was the continued progress on HIV therapeutics and prevention, driven by the ongoing evolution of once-daily oral antiretroviral therapy, especially with 2-drug single-tablet regimens, and advancements in long-acting injectable therapies.

As of 2022, 89% of people with HIV in Canada were diagnosed, 85% of people diagnosed with HIV were receiving treatment, and 95% of people receiving treatment for HIV were virologically suppressed. At HIV Glasgow, presentations on oral antiretroviral therapy (ART) support ongoing efforts to increase the proportion of people living with HIV receiving treatment, by expanding treatment options in oral and injectable ART.

Ongoing Evolution of Oral ART
At the conference, I presented on the 4-year outcomes of the multicountry prospective BICSTaR study, highlighting the long-term safety and efficacy of bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in routine clinical practice. This study, which included both treatment-naive and treatment-experienced individuals with HIV receiving BIC/FTC/TAF, demonstrated that nearly all individuals who continued therapy remained virally suppressed, with no evidence of treatment-emergent resistance. These findings reinforce the high clinical standards set by current once-daily, next-generation integrase inhibitor–based regimens.

Furthermore, real-world data continue to support the use of the single-tablet regimen dolutegravir (DTG)/lamivudine (3TC) in routine clinical practice, reinforcing its safety, efficacy, and robust genetic barrier, which are comparable with those of traditional 3-drug, next-generation integrase inhibitor–based regimens. 

And what about people with low CD4+ cell counts? Initially, for people with baseline CD4+ cell counts <200 cells/mm3, the GEMINI studies reported slightly lower virologic efficacy with DTG/3TC compared with DTG + FTC/tenofovir disoproxil fumarate (TDF), primarily because of nonvirologic factors. However, data from the DOLCE study, presented by Dr. Pedro Cahn, addressed this outstanding data gap by evaluating DTG/3TC vs standard triple therapy (DTG once daily + TDF/FTC or TDF/3TC once daily) in treatment-naive individuals with low baseline CD4+ cell count across 11 sites in Argentina and Brazil. At Week 48, both intention-to-treat and per-protocol analysis revealed no difference in virologic suppression between the 2 regimens. Of note, no emergent viral resistance was observed in either group, providing reassurance about the safety and efficacy of DTG/3TC in individuals with low baseline CD4+ cell counts.

Long-Acting ART in Community Settings
Long-acting (LA) cabotegravir (CAB) and rilpivirine (RPV) was approved for treatment of HIV in Canada in 2020, but access remains limited. More evidence is needed to show real-world persistence and adherence to injectable ART and provide rationale for broader implementation of LA ART.

To this end, for people transitioning to LA CAB and RPV in Canada, a patient support program assists with navigating reimbursement pathways and provides support for injections and appointment reminders. Many injections are administered in community pharmacies or alternative care settings outside of the traditional clinic environment. In my province, many of these injections are even often administered in a patient’s place of residence. A retrospective analysis was presented from this program and showed very high rates of adherence to on-time injections and very high persistence on therapy with more than 1 year of follow-up, demonstrating that injections can be provided in a variety of community settings successfully.

HIV Prevention in Canada
Currently, once-daily generic FTC/TDF is publicly funded for HIV prevention in many Canadian settings. A cost-effectiveness analysis compared the public health impact of LA injectable CAB vs generic FTC/TDF for HIV prevention. The analysis demonstrated cost effectiveness advantages for long-acting cabotegravir, supporting its recommendation from the Canadian Agency for Drugs and Technologies in Health. This favorable recommendation hopefully will lead to public funding for injectable HIV prevention options such as CAB and, in the future, lenacapavir.

Your Thoughts?
What are your thoughts on the evolving LA therapies on the future of HIV treatment and prevention? Get involved in the discussion by posting a comment below!