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IAS 2023 Introduction
IAS 2023: My Thoughts on Key Presentations Anticipated in Brisbane

Released: July 21, 2023

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Key Takeaways
  • The 12th International AIDS Society Conference on HIV Science presents cutting-edge research in the science of HIV.
  • Included in the program are reports on treatment, adverse events, and prevention, as well as coinfections and key populations.

The 12th International AIDS Society Conference on HIV Science (IAS 2023) brings to Brisbane, Australia, scientists and healthcare professionals who will present the most critical advances in basic, clinical, and operational HIV research that move science into policy and practice. With more than 60 symposia and oral abstract sessions, keynote presentations, and expert-led invited-speaker sessions, this meeting is the foremost conference on HIV science. Plenary sessions this year will engage experts in discussion on the role of antibodies in vaccines and cure, long-acting technologies, the latest in HIV and sexually transmitted infection prevention, moving toward HIV elimination, understanding the HIV reservoir, addressing human papillomavirus‒related cancers among people living with HIV, and global HIV migration, mobility, and health equity.

The oral abstracts and posters will showcase some of the latest scientific advances in HIV. Here’s my take on some of the key clinical data that will be presented.

Treatment
IAS 2023 will feature exciting reports on new treatment regimens. Included among these are the results of a large phase III trial of the nonnucleoside reverse-transcriptase inhibitor doravirine coupled with the oral investigational nucleoside reverse-transcriptase translocation inhibitor islatravir (both given once daily) compared with once-daily bictegravir/emtricitabine/tenofovir alafenamide in a double-blind trial of previously untreated persons.

The HIV capsid inhibitor lenacapavir in its SC injectable form is a twice-yearly treatment option for people living with multidrug-resistant HIV. Persons living with HIV who will have lenacapavir as their regimen undergo induction with an oral version of the drug given with an optimized background regimen. New reports investigate the use of the oral version as a bridge if doses are missed or cannot be given.

The primary 48-week results from the JABS trial will be presented, detailing the implementation of another long-acting regimen—cabotegravir plus rilpivirine—in vulnerable populations with complex needs.

Another very interesting report will challenge our long-standing assumptions about the efficacy of 2-drug regimens in persons with resistance. The SOLAR-3D study describes efficacy of switching to dolutegravir/lamivudine, even in persons with resistance including M184V/I and history of multiple virologic failures. This has been a concern with the use of this regimen; these data will be very interesting to see.

Adverse Events
We will hear for the first time the primary results from the REPRIEVE study comparing pitavastatin with placebo for cardiovascular prevention in people living with HIV. In April 2023, it was announced that the study would be stopped early after a planned interim analysis found a significant reduction in major adverse cardiovascular events with the use of pitavastatin.

In the past several years, we have witnessed a phenomenon of weight gain, changes in body composition, increasing BMI, dyslipidemia, and hypertension upon starting treatment with integrase strand transfer inhibitors (INSTIs). These adverse events are a concern with these highly effective treatments. Many papers will address this trend in both high-income and low-income settings. Others will describe antiretroviral switching strategies to address these weight and metabolic changes.

Persons who are pregnant often are excluded from clinical trials studying the safety and efficacy of new antiretroviral drugs or regimens. A systematic review and meta-analysis looked at adverse events and perinatal outcomes associated with antiretroviral therapy use in pregnant persons. This paper will increase our understanding of the safety and efficacy of newer therapies. Another report will look specifically at bictegravir/emtricitabine/tenofovir alafenamide as switch therapy in pregnant persons.

Prevention
AIDS 2022 presented exciting research that looked closely at the efficacy and safety results of long-acting cabotegravir as pre-exposure prophylaxis (PrEP) from HPTN 084. A report on initial PrEP product choices from the open-label extension of this trial will be presented this year, as will an analysis of the positive predictive value of the different HIV testing strategies employed in the study. We also will hear about the feasibility of long-acting injectable cabotegravir PrEP provision by community health workers.

Inequities in PrEP use remain prevalent. One study being presented will evaluate racial disparities in HIV incidence and PrEP nonadherence among men who have sex with men and transgender women using oral PrEP in Brazil.

As tenofovir alafenamide‒based PrEP choices have come into wider use, the adverse events associated with those options have been studied. Two papers from Kaiser Permanente in California look at incident hypertension and statin initiation in adults starting tenofovir alafenamide‒based PrEP.

Tuberculosis Coinfection
Some key presentations will address antiretroviral therapy in populations coinfected with or at risk for coinfection with tuberculosis (TB). Efficacy and safety data of efavirenz- and dolutegravir-based antiretroviral therapy with isoniazid and rifapentine for TB preventive therapy will be presented. We will hear about short-course rifapentine regimens given to persons living with HIV who are receiving INSTI-based regimens. There also will be a report on the rate of TB‒immune reconstitution inflammatory syndrome in those receiving INSTI therapy. Finally, a systematic review and meta-analysis of randomized, controlled trials will look at the efficacy and safety of different regimens in the treatment of people living with HIV with latent TB infection.

As the meeting unfolds, I encourage you to check the Clinical Care Options website for downloadable slides summarizing the data from these and other key studies. Also plan to join us for live webinars hosted by expert faculty providing their take on the clinical implications of the data. After the meeting, look for more ClinicalThought commentaries featuring expert perspectives on integrating new data into practice around the world.

Your Thoughts?
What data from IAS 2023 are you most anticipating? Share your comments in the discussion section.