ART: The Next 25 Years

This Symposium on the Next 25 Years of ART outlined the move towards injectables, broadly neutralizing antibodies and posited a shift in attitudes towards the treatment of children, championing their inclusion in clinical trials.


Integrating New Antiretroviral Therapies

Chloe Orkin, Barts Health NHS Trust, London, UK

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Dr Orkin: What does the future hold for HIV positive individuals? There are many new antiretroviral therapies in the pipeline, mainly injectable ART and long acting ART, currently in Phase 1-3 trials. Some might ask, is there a demand for injectables? From numerous surveys carried out in many countries, we know that many people prefer injectables to taking pills. We know this is the case from women using contraceptives who prefer having multiple choices of contraceptives and different modalities. Before switching to new available treatment, one must ensure first to “do no harm” and switch for a good reason, consider the efficacy of the drug, safety and tolerability.


Broadly Neutralizing Antibodies for HIV Prevention and Treatment: Dream or Pipe Dream

Daniel R. Kuritzkes, Brigham and Women’s Hospital, Boston, MA, USA

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Dr Kuritzkes: bNAbs: a human monoclonal antibody able to neutralize a wide range of HIV-1 isolates that also targets HIV-1 envelope and enhances various effector proteins is a new type of HIV treatment currently under Clinical trials.

Potential uses of bNAbs:

  1. HIV-1 treatment intensification Antiretroviral
  2. Maintaining HIV suppression for those on antiretroviral treatment
  3. HIV-1 Immunotherapy
  4. HIV-1 Prevention (mainly to prevent HIV acquisition by using as pre- or post-exposure prophylaxis

The potential advantages of bNAbs:

  1. It will require infrequent dosing
  2. There is no cross resistance with ART
  3. There is potential of overcoming adherence challenges
  4. Less stigma
  5. Potential to enhance HIV specific immunity

Current challenges:

  1. Cost
  2. Capacity
  3. Dosing frequency
  4. Global access
  5. Acceptability of infusion/injectables


Antiretroviral Therapy in Children: Present Challenges, Future Opportunities

Helena Rabie, Stellenbosch University, Cape Town, South Africa

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Dr Rabie: Presented a case scenario of one of her current patients in Cape Town, South Africa. Baby M was born weighing 1.8kg from a 36 year old lady found to be both HIV and TB positive with CD4 count of 26 and Viral load of 5.3 log. Baby was also found to be both HIV and TB positive. How does one care for this baby? What is the current ART available? Babies born with HIV need to be managed throughout their lives and current ART formulations do not address the needs of children and most children are not able to have 1st line ART therapy until they are over 3 years of age, either because of their weight or because of potential harmful side effects in young individuals. Most children have poor virological suppression, with only 50% on treatment achieving virological suppression. Why do children have low suppression? A lot of them are lost to follow up and a majority unable to have 1st line ART treatment. Most babies are having AZT/3TC/NVP but a lot are born with resistance HIV virus. Most toddlers weighing 10 kilos will have to take 4 tablets twice a day (8 tablets per day). ART in children is not only less effective but it has high pill burden and is less tolerable.

By most clinical trials excluding children as participants, these children will not only have increased risk of drug toxicity and increased virological failure but also very poor health outcomes. If we were to treat these children early with 1st line therapies, we would be giving them a fighting chance and a better quality of life because we know that there is greater opportunity for the immune system to regenerate in children and they will also have less HIV reservoir. Children treated early can be seronegative and have low levels of the HIV virus. The next of 25 years of ART needs to focus in children and women in order to end the HIV epidemic!


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