Dr. Chris Vinnard provided this update on HIV/AIDS care and treatment at the March 14, 2013 Philadelphia EMA Ryan White Planning Council meeting.

1. Christopher Vinnard, MD MPH MSCE
Assistant Professor of Medicine
Division of Infectious Diseases & HIV Medicine
Drexel University College of Medicine

2. A new report of a cure...

5.  Infant exposure to HIV was confirmed through review
of maternal HIV antibody and plasma viral load
testing
 Infant infection was documented by plasma viral load
testing
 ART (Combivir + Nevirapine) initiated in the infant at
30 hours of age
 Persistence of HIV following treatment
discontinuation was assessed using plasma viral load,
proviral DNA, and HIV antibody testing
 Ultrasensitive assays done at age 24 and 26 months
CROI 2013

6.  Infant infection was confirmed by positive
HIV DNA and RNA testing on 2 separate
blood samples obtained on 2nd day of life
 3 additional plasma viral load tests on day 7,
12, and 20 were positive, before reaching
undetectable levels at age 29 days
 Plasma HIV RNA remained undetectable
between months 1 through 26, despite
discontinuation of ART at age 18 months

7.  Ultrasensitive methods found a single copy of
HIV RNA in plasma at age 24 months
 Replication-competent virus was not
detected following co-culture of 22 million
purified resting CD4+ T cells
 Plasma viral load, PBMC DNA, and HIV-
specific antibodies remained undetectable
with standard clinical assays

9. What about the first patient cured
of HIV infection?

11. New approaches to treatment:
Targeting the CCR5 Receptor

15. “When to start treatment?”
New recommendations

18.  Benefit to the patient
 AIDS defining events
 Cancers
 All cause mortality
 Benefit to the patient’s partner
 ART was 96% effective in reducing transmission
between discordant couples

22. A new one-pill-once-daily regimen

28. A new indication for antiretroviral
therapy

35. http://www.cdc.gov/hiv/prep/

36.  Risk Evaluation and Mitigation Strategy
 Manage known or potential serious risks with
a drug or biological product
 FDA sometimes determines that a REMS is
needed in order for the benefits to outweigh
the risks of an approved drug
 REMS may include: Medication Guide,
Patient Package Insert, communication plan,
and other elements to assure safe use

38. New treatments (and new drug-drug
interactions) for hepatitis C co-infection

40.  ~30% if HIV-infected individuals in the U.S.
are co-infected with hepatitis C
 Chronic hepatitis C infection is a leading
cause of liver disease and mortality in HIV-
infected patients
 HIV/hepatitis C co-infected patients are at
greater risk for liver disease and death,
compared with hepatitis C patients without
HIV infection

41. Telaprevir + PegIFN/Ribavirin Boceprevir + PegIFN/Ribavirin
PegIFN/Ribavirin PegIFN/Ribavirin

43.  Telaprevir
 NRTI backbone plus either raltegravir, efavirenz,
atazanavir/ritonavir, etravirine, or riplivirine
 With efavirenz, increase dose of telaprevir
 Boceprevir
 NRTI backbone plus raltegravir
 Wait...
 New treatments on the horizon for 2014

44.  New report of a cured patient
 New research towards a “functional cure”
 New guidelines for “when to start” therapy in
different patient populations
 New one-pill-once-daily treatment regimen
 New indication for antiretroviral therapy
 Pre-exposure prophylaxis
 New hepatitis C treatments, and new drug-
drug interactions with antiretroviral therapy

45. Thank you!