News from CROI 2024: Cardiovascular disease risk higher than previously feared, 'weekly pills' and promising approaches to managing high blood pressure
CROI, or Conference on Retroviruses and Opportunistic Infections, is a conference and forum focusing on retroviruses and viral diseases. During this year's conference, which took place in Denver, Colorado between March 3 and 6, several news stories about HIV emerged. HIV-Sweden monitored the event and has compiled three of the most talked about news from the conference.
One pill a week could soon become a reality
Treatment for HIV in the form of tablets has been the most common approach since the breakthrough of antiretroviral treatment for HIV in the mid-1990s. For most people living with HIV today, treatment involves taking either one or two tablets a day. For a few years now, treatment has also been available in the form of monthly injections called Cabenuva. The injections are given in hospital and need to be taken at regular intervals within a window of about two weeks. Tablets with a longer duration of action are also now available, which could mean that tablets only need to be taken once a week.
In a presentation at CROI, Professor Russ Carstens from the pharmaceutical company Merck presented new data from two studies with the preparation MK-8725, a new drug that is one of the first in its category, nucleoside reverse transcriptase translocation inhibitor.
In the first study, 37 people living with HIV were tested with MK-8725. The participants were divided into five groups and given different doses, from 0.25mg to 10mg. Researchers then examined how well the drug worked against the HIV virus and concluded that doses above 5mg were sufficient to effectively treat HIV. In a subsequent study, 32 people not living with HIV tested MK-8725 for three weeks. The group was divided into four smaller groups and given doses ranging from 5mg to 40mg once a week. At the end of the study, the researchers found that the drug would remain in the body between 216 and 291 hours, without a new dose. The results showed that taking one pill of MK-8725 a week would be enough to treat HIV.
News about another drug, GS-1720, was also shared at CROI. Dr. Carl Fichtenbaum from the University of Cincinnati reported on a study done with GS-1720, a drug in the integrase inhibitor class. The study tested doses of 30mg up to 900mg of GS-1720 among people living with HIV. The researchers concluded that a dose of 450mg effectively treated HIV and remained in the body at a sufficient dose for almost 10 days. No serious side effects were reported and the drug was generally well tolerated by the participants.
There are also other studies and attempts to develop a treatment involving only one or two tablets per week. Dr. Amy Colson from the Community Initiative Resource in Boston reported on a study with the drugs Lenacapavir and Islatravir that is showing good results and could pave the way for a weekly combination.
Risk of cardiovascular disease higher than previously feared - new guidelines in both UK and US
Several studies have confirmed that people living with HIV are affected by co-morbidities to a greater extent and at an earlier age. In general, it is estimated that common diseases such as diabetes and cardiovascular disease affect people living with HIV about 5 to 10 years earlier than the general population.
New data from a study called REPRIEVE shows that the risk of cardiovascular disease may be higher than previously thought. The study included 7 769 people with HIV aged 40 to 75 years, from five continents. The vast majority of study participants had a low or moderate risk of cardiovascular disease at screening. By following the participants, the researchers have discovered that more of the study participants suffered from cardiovascular disease than the research team initially expected. In particular, the risk appears to be higher in high-income countries. The study also shows that women have a two and a half times higher risk of cardiovascular disease than previously estimated.
Several countries have recently changed their guidelines, recommending that people living with HIV take blood thinners to prevent cardiovascular disease. In November 2023, the British HIV Association updated its recommendations for all people over the age of 40 to be offered blood thinners. In the US, the Department of Health and Human Services issued new recommendations in February 2024 that are broadly similar to the UK guidelines. In terms of the type of blood thinners recommended, Pitavastatin is by far the most commonly recommended.
For more information on REPRIEVE:
https://www.reprievetrial.org/
Promising method gives good results for managing high blood pressure
High blood pressure is one of the underlying causes of heart attacks and strokes, two conditions that can have major consequences for those affected. There are a number of ways to lower blood pressure, and thus reduce the risk of heart attack and stroke. Methods that have proved successful include increased physical activity, reduced salt intake, smoking cessation and reduced alcohol consumption. It is also possible to take antihypertensive medication.
A study from the US recruited 297 people with HIV and high blood pressure. Half of the participants followed their usual care plan with routine visits and tests. The other half took part in a specially designed program aimed at lowering the participants' blood pressure. The program consisted of home blood pressure measurement, evidence-based treatment algorithms, digital journal tools, and a nurse who coordinated and communicated with the patient. Participants in both groups were followed for 12 months and then evaluated. In the group with a specially designed program, more people received some type of treatment for high blood pressure and three times as many reached the goal of a blood pressure of 130/80, compared to the group that followed their regular care plan.
In addition to lower blood pressure, the program was found to lead to lower bad cholesterol as well as other health benefits.
For more information on the study:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815688
Several of the news items highlight that more needs to be done to develop care for people living with HIV in Sweden. There is also a need for updated guidelines and interventions to better monitor the health of people living with HIV. The health challenges of today and the future will be different, and it is important that the healthcare system has the knowledge and resources to deal with this. HIV-Sweden is constantly working to help ensure that healthcare develops in harmony with the needs of people living with HIV. Do you have questions or concerns about any of this news or the care you receive today? Please contact us!