5 of the Top Recently-Published Articles on HIV

Annually, the Journal of Pharmacy Practice publishes a list of the most significant publications covering infectious disease pharmacotherapy from the previous year. Its August 2017 issue contains the most important of summaries from 2016. From more than 16,000 articles published in 2016, the authors selected 11 of great importance to pharmacists. In addition, the 5 top articles on subjects related to HIV/AIDS were ranked.¹

Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) for virologically-suppressed adults²

The global study enrolled 959 patients in the TAF group and 477 in the TDF group. Virologic suppression was generally successful in both arms, with the TAF arm achieving 12% noninferiority margin and demonstrating superiority of 4.1%. Patients on the TAF-based regimen were able to maintain their neurologic suppression with better bone marrow densities and kidney function than those in the TDF arm. The authors noted that the study, which ran for 96 weeks, has limited implications for long-term results on bone marrow density and glomerular filtration rate. More study is needed.

Antiretroviral therapy's impact on preventing HIV-1 transmission³

This study revealed that early initiation of ART decreases the number of genetically linked HIV-1 infections in sexual partners of individuals with HIV. In the trial, 1763 serodiscordant couples were enrolled and assigned to either an early-ART initiation group or a delayed-ART initiation group. After a median follow up of 1.7 years, the researchers determined that early ART was associated with a 96% lower risk of genetically linked HIV-1 infection than was delayed ART.

The use of HIV antibody VRC01 on viral rebound after patients experience a treatment interruption⁴

VRC01 is a broadly neutralizing antibody targeting the HIV CD4-binding site, and in this study of just 24 participants, VRC01 slightly delayed plasma viral rebound but did not maintain viral suppression at week 8. No safety concerns were identified with passive immunization with a single VRC01.

Glomerular function decline related to TDF in uninfected individuals to determine its reversibility⁵

The researchers conducted a randomized, placebo-controlled trial of daily oral TDF and emitricitabine (FTC)-TDF PrEP among hetereosexual members of serodiscordant couples who were not infected with HIV-1. Among the 4640 individuals in the study, the researchers noted that TDF-based PrEP was associated with a small reduction in mean estimated glomerular filtration rate (eGFR) that corrected itself after discontinuation.

Tenofovir-emtricitabine for HIV pre-exposure prophylaxis (PrEP) in individuals with active hepatitis B⁶

This study, with nearly 3000 participants, showed that clinicians can safely provide PrEP to individuals with HBV without concern of cirrhosis or substantial transaminase elevation.After stopping daily oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF), 5 of the 6 participants in the active arm maintained normal liver function except for a grade 1 elevation in 1 participants at week 12.

The authors identified these studies as significant continuing or emerging areas of research in HIV. Pharmacists should note that all but 1 of these articles are in the public domain and available free of charge on PubMed.gov.

References

• Fong G, Skoglund EW, Phe K, et al. Significant publications on infectious diseases pharmacotherapy in 2016. J Pharm Pract. 2017 Jan 1:897190017727212. doi: 10.1177/0897190017727212. [Epub ahead of print]
• Mills A, Arribas JR, Andrade-Villanueva J, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in antiretroviral regimens for virologically suppressed adults with HIV-1 infection: a randomised, active-controlled, multicentre, openlabel, phase 3, non-inferiority study. Lancet Infect Dis. 2016;16(1):43-5
• Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830-839.
• Bar KJ, Sneller MC, Harrison LJ, et al. Effect of HIV antibody VRC01 on viral rebound after treatment interruption. N Engl J Med. 2016;375(21):2037-2050.
• Mugwanya KK, Wyatt C, Celum C, et al. Reversibility of glomerular renal function decline in HIV-uninfected men and women discontinuing emtricitabine-tenofovir disoproxil fumarate preexposure prophylaxis. J Acquir Immune Defic Syndr. 2016;71(4):374-380.
• Solomon MM, Schechter M, Liu AY, et al. The safety of tenofovir-emtricitabine for HIV pre-exposure prophylaxis (PrEP) in individuals with active hepatitis B. J Acquir Immune Defic Syndr. 2016;71(3):281-286.