In recent years, a “big emphasis” in the treatment of HIV has been placed on the development of tenofovir alafenamide and the increasing number of combination regimens, according to Ann Collier, MD, professor of medicine in the division of allergy and infectious diseases and director of the AIDS Clinical Trials Unit at the University of Washington and associate director of the Center for AIDS Research at the University of Washington and Fred Hutchinson Cancer Research Center.
Tenofovir alafenamide (Gilead Sciences; TAF) is similar to tenofovir disoproxil fumarate (Gilead Sciences; TDF) but works by a “slightly different mechanism.” TDF is well known and commonly used in first-line treatment, but may cause kidney problems, according to Collier. Patients who have kidney problems or who are at risk for them will “greatly benefit” from TAF. The agent may be adopted in other patient populations as well, but uptake will depend on pricing and insurance coverage, she said.
Combination therapies have benefitted all patients with HIV in developed countries, according to Collier. Depending on the agents comprising the single-tablet regimen, these therapies can be particularly advantageous for certain sub-populations of patients with HIV.
But there are patients who continue to struggle with adherence and disease management in spite of the benefits seen with both TAF and combination therapies, according to Collier. As a result, the need for novel therapies and better management strategies continues.
Reasons for suboptimal disease management and outcomes in HIV are varied, Collier told Infectious Disease News. These factors include the presence of comorbid conditions, issues with adherence to medication and drug-drug interactions.
Combination regimens have led to success for the “vast majority of people who have HIV,” but some patients still face “a great challenge” in their disease management. Reasons for non-adherence include other health problems, including mental health and substance abuse issues, and distrust of the medical system.
These patients “do not have the ability to adhere to current therapies – and we need new strategies to treat those individuals,” Collier told Infectious Disease News. Potential approaches include enhanced social support and long-acting ART regimens.
Drug-drug interactions may be another barrier to effective management of HIV for some patients, but the array of modern regimens that are available mean “it is usually possible to find a regimen that doesn’t interact with everything that a patient is on.”
However, in spite of these challenges, numerous strides have been made since the epidemic began 35 years ago, according to Collier.
“In the early years of HIV, people took very large numbers of pills multiple times a day. Now, the most commonly used regimens are one pill, once a day,” she said. “Individuals who have successfully treated HIV now live almost as long as individuals who don’t have HIV, as long as they know they have HIV, have access to care and adhere to their treatments.” – by Julia Ernst, MS
Disclosure: Collier reports no relevant financial disclosures.