BY TIM HORN
PREVENTION
TREATMENT
CURE
CONCERNS
Is Selzentry (maraviroc) the next best pre-exposure prophylaxis, or PrEP, for HIV-negative individuals looking to avoid contracting the virus? A clinical trial dubbed NEXT-PrEP, which was announced in July, is looking to find out. Selzentry could be a useful alternative to Truvada, the only approved PrEP option, as it targets CD4 cells, not the virus. This potentially means less drug resistance—a concern for Truvada PrEP users who may need the drug, and others like it, if they later become infected. Curiously, just one week after the clinical trial was announced, CDC scientists reported that maraviroc failed to protect monkeys from rectal infection with the virus. The results might not bode well for humans—only studies will tell—though NEXT-PrEP researchers say Selzentry doesn’t work as well on monkey cells as it does on human cells.
Dolutegravir, the once-daily integrase inhibitor that doesn’t require boosting, continues to leave a trail of encouraging news on its path to approval. Combined with the dual-nuke tablet Epzicom (abacavir and lamivudine)—and a pill containing all three drugs is in development—dolutegravir made a rare achievement in an ongoing Phase III clinical trial: an efficacy advantage over that of a tried-and-true standard, Atripla, in first-time treatment takers. Reported at a September conference, preliminary data from the 830-person SINGLE study found that 88 percent of those using dolutegravir and Epzicom had undetectable viral loads, compared with 81 percent using Atripla— a difference that was statistically significant, meaning it was too great to have occurred by chance. Also encouraging: Dolutegravir is active against strains of HIV resistant to Isentress (raltegravir) and elvitegravir, suggesting that it may also be useful for people who no longer respond to them.
A group of HIV-positive French individuals—14 at last count—may be yet another piece of the cure puzzle. Comprising the VISCONTI cohort, they were all started on HIV treatment within 10 weeks of becoming infected, remained on therapy for an average of three years, and have subsequently stayed off treatment for roughly six years, all the while maintaining undetectable viral loads. They’re not “elite controllers”—they don’t have the same immunologic characteristics as those able to naturally control the infection—and their prolonged time off treatment makes them unique among other early treaters. Have these individuals been “functionally cured,” whereby HIV is still present but effectively controlled without the need for meds? Nobody has declared them as such. But they’re a model for this approach as scientists continue to tease out what separates these individuals from the rest.
HIV-positive people who experience a heart attack and require hospitalization are more likely to die, compared with those not living with the virus, say the sobering results of a U.S. data analysis. The review included 1.5 million hospital admissions related to heart attacks recorded between 1997 and 2006 by a nationwide survey. After adjusting the data for differences between individuals with and without HIV, the risk of death was roughly 38 percent higher among those living with the virus. Though the reasons for this disparity aren’t yet clear, the study authors noted that HIV-positive patients were less likely to receive standard cardio care while hospitalized, such as anticoagulants, angiography or bypass surgery. More research is necessary, but in the meantime, the researchers warn that health care providers need to recognize the increased risk of death among people Senator living with HIV and act Bernie accordingly. Sanders
Selzentry Is PrEP Contender
28 POZ DECEMBER 2012 poz.com
Dolutegravir Shows Promise
Curious Cohort on Early Treatment
Fewer Comebacks From Heart Attacks
(I-Vt.)
ALL IMAGES ISTOCKPHOTO.COM: (MEN) BONNIE SCHUPP; (HIV) INGRAMPUBLISHING; (EIFFEL TOWER) MLENNY PHOTOGRAPHY; (CLOUD) MAGEDEPOTPRO
RESEARCH NOTES