IAS 2007, Sydney Australia

Pa m a g oa z i n e sf o r pie o tp l e il i vvi n g wei t h h iLv / a i d s i! ovc t o b ie r 2n0 0 7 g IAS 2007, Sydney Australia PROMISING SIGNS, MORE COMMUNITY INVOLVEMENT, NEW TREATMENTS BY PAUL KIDD the partnership was threatened by want to help people, not judge recent political developments. them.” major HIV/AIDS “Recent comments by high Maura Mea, an HIV- medical conference in governmental authorities have cast positive woman from Papua Sydney has generated doubt on Australia’s commitment New Guinea, reminded the lots of news on the to reduce stigma and discrimination audience of the importance of treatments front. for people living with HIV,” said maintaining a strong Several of the big guns IAS president Pedro Cahn. involvement by people living of recent HIV drug “Fortunately, neither the scientific with HIV/AIDS in the development have community nor the Australian response to the epidemic, in continuedA to perform well in clinical people support these statements. our region and globally. trials, and there are promising signs in We stand united with local and “One of the keys to dealing with toxicities, neurological global AIDS community to ensure addressing the HIV epidemic is complications and more. that people living with HIV have to address stigma and The International AIDS Society the right to travel without discrimination,” she said. “An conference on HIV Pathogenesis, harassment or the requirement to important way of doing this is Treatment and Prevention is held disclose their HIV status.” to put a real human face to every second year. It’s one of the Professor David Cooper, of the epidemic and embrace the major events on the HIV calendar, Australia’s National Centre in HIV principles of Greater and regularly delivers significant news. Epidemiology and Clinical Research, Maura Mea from Papua New Guinea Involvement of Positive People This year’s IAS conference was held said Australia’s partnership is speaking at the opening ceremony of (GIPA) in decisions that affect right here in Australia, at the Sydney “worth not just saving, but actively the conference their lives. Those principles Convention Centre from 22-25 July. nurturing.” But he warned that are as important today as they This was the biggest HIV-related recent rises in HIV infections meant restrictions on HIV-positive people were when they were first developed conference ever held in Australia, the partnership was in danger of coming to Australia on tourist visas, in 1994.” attracting more than 5000 clinicians, fragmenting as the issue becomes and there was no intent to change activists and government increasingly politicised. this. But for people seeking NEW DRUGS representatives from around the world. “Pointing fingers of blame will do permanent residency, he confirmed There is a lot of excitement about new At the opening session, speakers nothing to curtail infections,” he told the government’s intention to treatments at the moment, with repeatedly referred to the contentious the crowd. “Threatening to demonise implement new restrictions. several new agents, many from plans by the federal government to people living with HIV infection will Australia is a “big-hearted and entirely new drug classes, currently in place new restrictions on HIV-positive not help. Making recent immigrants compassionate country,” Abbott said, late-stage trials. The good news is that immigrants. from developing countries the alleged however applicants for permanent many of these drugs are continuing to While Australia’s long-standing culprits will not help.” residency will have to give “enforceable perform well, displaying strong partnership between government, Federal health minister Tony undertakings” to seek treatment. efficacy and good tolerability. researchers and affected communities Abbott, representing the Australian But he stressed that the measures was applauded, speakers warned that government, noted that there are no were being introduced “because we CONTINUED PAGE 2 CONTINUED FROM PAGE 1 who were randomly assigned to receive either maraviroc or INTEGRASE INHIBITOR efavirenz, plus Combivir (AZT Raltegravir (Isentress, plus 3TC). The study is formerly MK-0518) is an looking to see the proportion experimental integrase of people who achieve inhibitor being developed by undetectable viral loads (below Merck. Integrase inhibitors 400 copies/ml and below 50 target a different part of the copies/ml) at week 48. HIV life cycle to existing The results showed that in treatments – by interfering this trial, maraviroc was with the integrase enzyme, ‘statistically non-inferior’ to which HIV uses to insert its efavirenz in the number of viral DNA into human cells. patients below 400 copies, As they represent an entirely but performed slightly less new class of HIV drugs, the well in achieving viral load development of effective below 50 copies: 65.3 percent integrase inhibitors has the of participants taking maraviroc potential to radically improve had viral load below 50, treatment options. compared with 69.3 percent Forty-eight week data from of those taking efavirenz. The a major phase-2 trial of drug was however well- raltegravir was presented to tolerated, with similar rates the conference, with the drug of discontinuation in both showing similar efficacy to study arms, and importantly efavirenz in people who had there were no signs of not previously taken HIV Exhibition stands at the IAS conference increased rates of malignancies treatments. The 189 people in patients taking maraviroc. participating in this study response to it, while four results and show that this new class, and again 48-week The issue of increased were randomly assigned to others had an initial response new treatment is very results from a clinical trial malignancies has led to the one of five groups, four of followed by a viral rebound. effective in treatment-naive were presented in Sydney. abandonment of other drugs which took different doses of At 48 weeks, more than 83 people and relatively easy to CCR5 inhibitors work by in this class, and continues to raltegravir; the fifth group percent of people taking tolerate. There are also signs blocking one of the co- cloud another CCR5 inhibitor received efavirenz at the raltegravir had viral load that raltegravir is capable of receptors used by HIV to gain being developed by Schering- standard dose. All below 50 copies/ml. There producing much faster entry to human cells. There Plough, vicriviroc, which was participants also took Truvada were very few cases of people reductions in viral load has been some concern about the subject of a separate (FTC plus tenofovir). The discontinuing treatment due compared to efavirenz, and them because HIV is able to presentation in Sydney. Week objective was both to see to side effects or toxicity while the clinical significance use an alternative co-receptor 48 data from a study whether raltegravir was as problems, a sign that the drug of this is not yet understood, (CXCR4) in some people, and involving 188 treatment- effective as efavirenz, and to is well tolerated. Diarrhoea it does suggest that, assuming so the participants in this experienced people were find the most appropriate was somewhat more common further trials continue to trial had been pre-screened to presented, updating earlier dose of the new drug. among people taking higher report good results, this drug ensure they had ‘R5-topic’ results unveiled at last year’s The rate of virologic failure doses of raltegravir compared will have a big role to play in virus, which uses the CCR5 International AIDS (defined in this study as with efavirenz, while CNS HIV therapy in the future. co-receptor. People with ‘X4- Conference in Toronto. having a viral load over 400 side effects such as abnormal tropic’ or mixed virus were Vicriviroc produces very at the 24-week mark) was dreams, and increases in CCR5 INHIBITORS excluded from this trial and are pronounced drops in viral similar in both the raltegravir cholesterol and triglycerides Maraviroc (Celsentri) is a unable to use this treatment. load (about 2 logs) at both and efavirenz groups at about were significantly more common CCR5 inhibitor being The MERIT trial is a phase- the 10mg and 15 mg doses, 3 percent. Only one person in those taking efavirenz. developed by Pfizer. This is 3 study involving 721 however a 5mg arm in this taking raltegravir had no These are impressive another drug from an entirely treatment-naive participants, trial was discontinued due to between the trial and ARV positive individuals with Aptivus now treatment services were hepatitis C had smaller available on PBS available to all participants increases in their CD4 cell From September 2007 TREATMENTSBRIEFS who seroconverted while on count after starting HIV Aptivus (Tipranavir), a new the trial. therapy than patients who protease inhibitor became were only infected with HIV. available for S100 Treatment for Vicriviroc remains effective prescribing in Australia. in treatment-experienced Manufactured by Boehringer designed to test whether the Sydney. In this analysis the Hepatitis C co patients, according to data Ingelheim, the 250mg soft vaccine prevented HIV outcome was 'futility' - there infection does presented at the 4th capsules have been infection; or whether was no difference in either International AIDS Society approved for listing on the vaccinated individuals who HIV acquisition in the vaccine not significantly Conference in Sydney. Pharmaceutical Benefit later seroconvert would have and placebo arms, nor was impair

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