The success with which HIV and AIDS is treated has dramatically improved over the last few decades.
Just 35 years ago, the virus was viewed by many as a death sentence. I remember it clearly, as the disease began to emerge around the time that I was starting out as an infectious diseases physician. There was a great fear of the unknown, with researchers and health care professionals determinedly trying to understand this new virus, which was infecting and killing large numbers of people.
Fast forward to today, and we have seen remarkable success in HIV treatment. In fact, early diagnosis and treatment with daily antiretrovirals (ARVs) means that patients with HIV can expect to live a regular lifespan.
However, this doesn’t mean that our work is done. Globally, there are nearly 37 million people living with HIV (PLHIV), and many treatment-related needs still exist. Even with effective treatment, PLHIV may have to deal with side effects and health conditions caused by long-term exposure to their HIV medicines, as well as potentially having to manage their condition alongside other conditions related to ageing – such as diabetes and cardiovascular disease.
No patient should have to take more medicines than they need
Patients diagnosed with HIV today will be on their treatment for many decades, so it’s important that we focus on treatment options that could potentially help lessen the lifetime burden of HIV therapy on the lives of PLHIV.
Nobody should have to take more medicines than they need. While three-drug regimens of ARVs are the current standard of care that physicians prescribe for PLHIV, three drugs may not be necessary for many patients.
For these patients, a two-drug regimen, or 2DR (formerly called dual therapy) may not only control the virus but may also help address potential issues associated with a lifetime of treatment, such as long-term toxicities and drug-drug interactions. These could be especially important as PLHIV age.
Recent evidence with 2DRs
The data presented at the recent AIDS 2018 conference in Amsterdam from the GEMINI and SWORD study programmes added to the growing body of evidence around two-drug regimens.
The GEMINI I and II studies evaluated the safety and efficacy of a 2DR of dolutegravir and lamivudine compared to a three-drug regimen of dolutegravir and two nucleoside reverse transcriptase inhibitors, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), in treatment naïve HIV-1 infected adults. The studies met their 48-week primary endpoint, which was to show that adults who had never received treatment for HIV could get a similar level of efficacy from the two-drug regimen as they could from taking the three-drug regimen.
Meanwhile, 100-week data from the SWORD 1 and SWORD 2 studies reinforced the longer-term profile of a 2DR with dolutegravir and rilpivirine for virologically suppressed PLHIV compared to traditional three- or four-drug antiretroviral regimens. Longer-term data showed that PLHIV who switched to the 2DR maintained viral suppression at 100-weeks, with a low rate of virologic non-response and no treatment-emergent resistance to the integrase inhibitor dolutegravir. No new safety risks were identified in these studies, and the data relating to certain surrogate markers for bone health and renal function improved with the 2DRs studied.
Building on findings like these could help give PLHIV as many treatment options as possible.
John Pottage is chief scientific and medical officer at ViiV Healthcare
