Editor's Note: The Infectious Diseases Week (IDWeek) is a premier global academic event in the field of infectious diseases, attracting nearly ten thousand experts and scholars annually to share the latest research findings and advances in diagnosis and treatment. The conference is rich in content and highlights, covering a wide range of frontier topics, including new diagnostic technologies, therapeutic drugs, artificial intelligence, and antimicrobial resistance. This article summarizes three key oral presentations from the conference on state-of-the-art HIV care and prevention.Implementation of Long-Acting Antiretroviral Therapy and Prevention
In the realm of HIV prevention and treatment, long-acting antiretroviral drugs have made groundbreaking progress:
- Cabotegravir/Rilpivirine (CAB/RPV): Provides a new long-acting treatment option for patients with low viral loads and no history of antiretroviral therapy (ART) failure.
- Cabotegravir (CAB): An important tool for pre-exposure prophylaxis (PrEP), offering new preventive measures for high-risk populations.
- Lenacapavir (LEN): Offers a new treatment option for patients with multidrug-resistant (MDR) HIV.
- Ibalizumab: Provides a new treatment pathway for patients with high viral loads and resistance to multiple drugs.
The implementation of long-acting regimens requires careful consideration of individual, institutional, and systemic factors, beyond strictly following guidelines to select eligible populations. Additionally, the successful implementation of these regimens depends on the coordinated efforts of healthcare providers, including clinicians, pharmacists, and nursing staff.
Diagnostic Challenges in Breakthrough Infections with HIV PrEP
Early diagnosis of HIV infection is critical for both individual and public health. For individuals, timely treatment can reduce immune system damage, slow disease progression, and limit the size of the viral reservoir. From a public health perspective, early diagnosis helps reduce viral transmission, advancing the goal of ending the HIV epidemic.
Despite the significant success of PrEP strategies in HIV prevention, breakthrough infections remain a challenge. Detecting these infections is particularly difficult when using long-acting PrEP formulations. Studies have shown that the use of CAB PrEP may delay the detection of HIV, increasing the risk of resistance to integrase inhibitors (INSTIs). Therefore, there is a pressing need for more sensitive point-of-care testing (POCT) tools to enable faster detection of HIV infections.
New Drug Applications in the HIV Treatment Pipeline
Over the past few decades, HIV treatment strategies have undergone dramatic changes. Initially, patients had to take multiple pills daily, a strategy that, while effective in suppressing the virus, was challenging due to poor adherence and significant side effects. With continuous advancements in medical technology, treatment regimens have gradually simplified. The introduction of fixed-dose combination (FDC) therapies allowed patients to achieve effective treatment with a single daily pill, significantly improving convenience and adherence. In recent years, the development of new drugs has led to the emergence of single-pill dual-drug regimens and long-acting injectable regimens, further simplifying treatment and reducing the burden on patients.
In the field of new drug development, particularly for patients on long-term ART who may face MDR challenges or need to optimize existing ART regimens to maintain virologic suppression, a series of new drugs and therapeutic options are providing new avenues for the treatment and prevention of HIV infection. These advancements not only offer clinicians more treatment options but also improve the quality of life and treatment prospects for patients. For different patient populations, the following newly approved or investigational drugs are available:
- ART Optimization for Virologically Suppressed Patients: Current Regimens: Long-acting CAB/RPV Future Options: Doravirine/Islatravir (DOR/ISL), Oral LEN/ISL, LEN/Bictegravir (BIC)
- Heavily Treatment-Experienced Patients: Current Regimens: Fostemsavir, Ibalizumab, LEN Future Options: Islatravir, Broadly Neutralizing Antibodies (BNAbs)
- ART-Naive Patients: Current Regimens: No new drugs in current guidelines Future Options: Long-acting oral and injectable options: LEN, Islatravir, BNAbs
These innovations represent significant strides in the battle against HIV, offering new hope and possibilities for both prevention and treatment. As research continues, the HIV treatment landscape will undoubtedly see further advancements, making it easier for patients and healthcare providers to manage the disease effectively.
