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31st Conference on Retroviruses and Opportunistic Infection
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Eric S. Daar, M.D.
Chief, Division of HIV Medicine
Harbor-UCLA Medical Center
Professor of Medicine
David Geffen School of Medicine at UCLA
The 31sth Conference on Retroviruses and Opportunistic Infections (CROI 2024) was very well organized with more than 1000 abstracts accepted, many related to HIV, sexually transmitted infections (STIs), viral hepatitis, metabolic abnormalities, and pathogenesis. I have selected to discuss key presentations in select areas of current and future clinical relevance. I will touch on the presentations that I thought were particularly interesting, providing a summary that includes what I considered the "headlines" followed by "study findings/Interpretation." Notably, there were many other highly relevant presentations at this meeting, and I encourage the reader to search the CROI 2024 site for those of interest that I did not have the time and/or space to cover below.
STI PREVENTION
A product of our success in HIV prevention are methods that do not require barrier protection, e.g., use of suppressive antiretroviral therapy by those infected and pre-exposure prophylaxis (PrEP) for those uninfected and at risk, is an increase in the incident of STIs. In fact, there has been a dramatic increase in STIs over the past several years that has been challenging to address. One of the more exciting strategies to address this problem and has recently been adopted by health departments and the Centers for Disease Control and Prevention for men who have sex with men (MSM) and transgender women (TGW) is the use of doxycycline post-exposure prophylaxis (PEP). In addition, there has been interest in developing a vaccine against Neisseria gonorrhoeae, particularly with ongoing threat of increasing antimicrobial resistance to this pathogen.
Headlines:
• DOXY-PEP extension data continues to demonstrate a significant reduction in gonorrhea, chlamydia, and syphilis infections amongst MSM and TGW (1). The therapy remains well tolerated and thus far there is limited evidence for increasing antimicrobial resistance.
• DOXYVAC study, with second randomization to meningococcal vaccine confirms earlier data showing doxycycline PEP reduced infection with chlamydia, syphilis and gonorrhea (2). However, an earlier signal that meningococcal vaccine may prevent gonorrhea was not confirmed with follow-up.
• Public Health data from SF shows reduction in STIs in the community after Doxy-PEP was endorsed for use in high risk MSM and TGW (3).
Study findings/Interpretation:
• The DOXY-PEP study was an open-label, randomized study that initially enrolled 637 MSM or TGW in two groups, those living with HIV and those on HIV PrEP and showed in both groups highly significant reduction in gonorrhea, chlamydia and syphilis. Of those enrolled, 279 contributed to the open-label extension phase presented at CROI 2024 (1). Consistent with the initial randomized data, significant reductions in STIs were seen, with at least one STI seen in 13% of those originally receiving doxy PEP who received it during the open label extension, similar to that seen during randomized portion of study. For those originally not given doxy PEP the infection rate went from approximately 30% during randomized portion of study to 18% during open label extension. The significant difference in STIs was true overall and for each of the three infections. Safety remained high throughout the randomized and then open-label portions of the study.
• DOXYVAC in iPergay with randomized to doxycycline PEP or not, and a second randomization to meningococcal vaccine. This study enrolled a subset of those who participated in iPergay, a study of on demand HIV PrEP in MSM and TGW (2). The study included HIV-uninfected individuals at risk for acquisition of STIs and randomized them to doxycycline PEP, given at 24, and no later than 72 hours after high-risk sexual encounter. A total of 545 were randomized 2:1 to doxy PEP versus no doxy, a highly significant reduction in incident rate (per 100 patient years) for chlamydia (42 vs. 5.9), syphilis (14.5 vs. 2.9), and gonorrhea (68 vs. 46). Tolerability was overall excellent in both study arms. Initial presentation of data suggested those randomized to meningococcal vaccine had lower rates of gonorrhea acquisition; however, with further analyses and follow-up, there was no interaction between doxy use and meningococcal vaccine and no evidence for the latter reducing risk of gonorrhea infection.
• Public Health data from San Francisco shows reduction in STIs in the community after Doxy-PEP was endorsed for use in high risk MSM and TGW (3). The Doxy-PEP study was conducted in San Francisco and Seattle. Shortly after the results became available, local health authorities in SF endorsed this strategy for MSM and TGW. At CROI 2024 epidemiologic data for STIs in SF before and after doxy PEP was endorsed by the health department was presented. There was a reduction in incident STIs during COVID-19, but a clear rebound in STIs after the worst surges of COVID-19 ended. There was also a notable decline in STIs that occurred shortly after the introduction of doxy-PEP as a public health tool to reduce STIs, but causation cannot be determined by the data. This was most notable for chlamydia and syphilis, with less apparent impact on gonorrhea, which might reflect degree of resistance of this bacterium to doxycycline in the community.
These presentations generated a great deal of discussion at CROI 2024. One key aspect related to ongoing concerns and need to monitor for impact on emerging doxycycline resistance to STIs, as well as other common bacteria in the community, e.g., staphylococcus aureus. The other question related to its utility in cis-gender women. Unfortunately, a recently published study of doxy PEP in this population did not show efficacy. Although a biologic explanation cannot be excluded for the latter observation, there is a strong sense that the negative study related to poor adherence, as was seen in some of the early HIV PrEP studies in cis-gender woman. The panel discussion largely focused on whether the field would require another large randomized-controlled trial in this population, or if alternative strategies could be employed to address this question and move doxy PEP forward in cis-women if it is likely to work, especially since we know that doxycycline is effective treatment in this population for chlamydia and syphilis.
HIV THERAPEUTICS
Long Acting (LA) Cabotegravir (CAB)/Rilpivirine (RPV)
The field of HIV therapeutics has matured a great deal over the past years with second generation integrase strand transfer inhibitors (INSTIs) being leaders for first, second, and even beyond second-line therapy for most people. The next big advance in treatment was the availability of long-acting (LA) therapy, particularly LA cabotegravir (CAB) plus LA rilpivirine (RPV) for those stably suppressed and without resistance to these agents. Most of the data with this regimen has included those from resourced countries and in those who are likely to be highly adherent to therapy. At CROI 2024 we heard more data about how this regimen can be used in different populations, as well as new drugs that can be given with less than daily administration.
Headlines:
• The CARES Study showed that LA CAB/RPV was highly effective and well tolerated by those stably suppressed on oral antiretroviral therapy (ART) in sub-Saharan Africa (4). It also showed efficacy in those with INSTI and RPV resistance mutations on ARCHIVED assays on peripheral blood mononuclear cells, and those with subtype A1 virus.
• Blips on LA CAB/RPV in SOLAR were no more common than with BIC/FTC/TAF and were not associated with virologic failure (5).
• HBV reactivation in those with history of HBV infection but not chronic (i.e., HBsAg or HBV DNA negative) are at low risk of HBV reactivation when switched to LA CAB/RPV, especially if they have detectable HBsAb (6).
• The LATITUDE Study enrolled those who were poorly adherent with oral ART without underlying resistance to NNRTIs (except K103N) or INSTIs (7). This study used financial incentive to get people virologically suppressed on oral ART and then randomly assigned them to LA CAB/RPV or continued oral therapy. The Data Safety Monitoring Board stopped the study early due to improved virologic suppression in those on LA regimen.
• WARD 86 follow-up showed that majority of viremic patients with poor adherence to oral ART, without underlying RPV or CAB resistance achieved viral suppression with LA CAB/RPV (8).
Study findings/Interpretation:
• The CARES Study randomized 512 participants in sub-Saharan Africa who were virologically suppressed on oral ART to remain on oral regimen or switch to q8 week LA CAB/RPV (4). The primary endpoint was proportion with viral rebound to >50 copies/mL at 48 weeks was 2.4% in LA CAB/RPV and 1.9% in continued oral regimen groups, very similar to the registrational trials for the regimen. Tolerability was good in both groups with most common AE being injection site reactions, most being grade 1 and 2 with only one in LA CAB/RPV discontinuing therapy due to an adverse event. Patients could not have previously failed an antiretroviral regimen, but many had experienced treatment with NNRTIs. Although no resistance data was available at randomization, they performed sequencing of proviral DNA from stored cells for drug resistant mutations. Interestingly, they reported high rates of efficacy were observed despite 10-15% having some evidence of NNRTI and/or INSTI resistance in proviral DNA. It is not clear what the explanation for this might be, or why there was such a high rate of resistance detected even though none of participants had previously experienced virologic failure. Understanding this finding is further limited by the lack of data on the specific mutations noted, that raises the possibility that some represent non-infectious virus and therefore not clinically relevant. Regardless of the explanation, it reminds us that we lack robust prospective data demonstrating the clinical relevance of drug resistant sequences identified in proviral DNA. Another important observation from this study was that more than 50% of participants had HIV subtype A1. Many may recall that subtype A1 is closely related to A6 with the latter being predominant in Russia. Early trials of LA CAB/RPV demonstrated a higher risk of virologic failure in those identified as "A1/A6," although without clear separation provided between these two subtypes in the analyses. Based upon data for the CARES study it seems clear that subtype A1 is not a risk factor for virologic failure with LA CAB/RPV.
• Viral blips were reviewed in the SOLAR study that enrolled participants that were virologically suppressed on BIC/FTC/TAF and randomized them to continue therapy for 12 months or switch to LA CAB/RPV every 2 months (5). The study previously reported high, and similar rates of continued suppression in both groups. After the first-year, open label LA CAB/RPV was available to all. The current analysis evaluated frequency of viral blips between 50 and 200 copies/mL (blip defined as single increase followed by value <50 copies/mL) between groups and if they were associated with confirmed virologic failure (VL repeatedly >200 copies/mL). The authors reported very low, and similar rates of blips between BIC/FTC/TAF (4%) and LA CAB/RPV (4%), with no virologic failures in any of those with blips. These results were consistent with what was observed in registrational trials of LA CAB/RPV (ATLAS, FLAIR and ATLAS-2M) and supports continued therapy and follow-up without change in treatment amongst those with isolated increase in VL to 50-200 copies/mL.
• HBV reactivation was evaluated for in those switching to LA CAB/RPV (6). People living with HIV who have chronic HBV infection, defined as HBsAg and/or HBV DNA detection should optimally receive a tenofovir-based antiretroviral regimen, without which they are at high risk for HBV progression. In those without chronic HBV infection, but evidence of past infection (HBcAb positive with or without HBsAb) are at variable risk of HBV rebound if HBV active drug is discontinued. In a retrospective cohort study, individuals with HBcAb alone (n=7) and those HBcAb and HBsAb positive (n=34) were followed for median of approximately 8 months after switch to DTG/3TC (37%) or LA CAB/RPV (63%). The authors reported that none of the HBsAb positive individuals experienced rebound and one of seven lone HBcAb positive experienced HBV viral rebound with dramatic elevation of transaminases and HBV DNA, both of which responded to the addition of tenofovir. This study is limited by its small size, being a retrospective cohort, and limited follow-up. Nevertheless, it does provide evidence that the risk of HBV reactivation after switching to a regimen without HBV activity in those HBcAb and HBsAb positive is low. The risk for HBV reactivation also appears to be relatively low, although present for those HBcAb positive without HBsAb. In both settings if switching off of an HBV active drug it is important to at least follow transaminases and have a low threshold for HBV DNA testing.
• The LATITUDE study (ACTG 5359) is one of the first to see if LA CAB/RPV could be safely used in a less adherent population (7). The concern with using LA CAB/RPV in this population relates to the ability to get these people virologically suppressed, since the majority of the clinical trial data and the current indication is limited to this population. There is also concern that poorly adherent individuals were not included in registrational trials, and they may be at increased risk of failing to return for injections. The latter issue is particularly important since missed doses can put individuals at risk for developing NNRTI and/or INSTI resistance. The LATITUDE study provided financial incentives to viremic individuals without evidence of resistance to NNRTIs (except K103N which would remain susceptible to RPV) or INSTIs, with the goal of achieving virologic suppression. Once suppressed, participants were randomized to either continue oral regimen or switch to monthly LA CAB/RPV. The study was stopped early by DSMB for meeting two of the pre-specified secondary endpoints comparing LA CAB/RPV to continued oral therapy with 7.2 vs. 25.4% experiencing virologic failure and 9.6 vs. 26.2% treatment-related failure, respectively. Notably, there was a trend but not a significant difference for the primary endpoint of regimen failure. The DSMB action occurred shortly before the meeting, so the data presented was limited to that seen during the planned interim review by the DSMB. More details will follow to address important issues, e.g., number with missed LA dosing, emerging resistance, and adherence in the open label continued oral therapy regimen. Pending this data, this trial does suggest that for those struggling with adherence to oral regimen the LA CAB/RPV may offer some benefit.
• The WARD 86 experience reflects open-label data from the HIV clinic at San Francisco general where those poorly adherent with ART were offered LA CAB/RPV, along with intensive wrap around services and follow-up provided by clinic and research staff (8). This data was previously reported and showed a subset of more than 50 individuals who were viremic when starting therapy were able to suppress their virus for variable period of time. Inclusion required no evidence of RPV or CAB resistance and willingness to be reached out to by staff if they missed a dose. It was reported that therapy was initially monthly, with some transitioning to every other month dosing. At CROI 2024, the WARD 86 team presented the data on 59 individuals with follow-up for approximately 48 weeks. They reported that 49 of 59 (83%) remained on LA CAB/RPV with 48 (81%) having plasma HIV RNA <50 copies/mL. One individual who remained on therapy had viral load >50 copies/mL, three others failed with resistance, and two were lost to follow-up with resistance. This data is very important because the enrolled individuals were very challenged by pill taking and therefore at high risk for disease progression. It was because of this that it was thought to be justified to expose the patients to this regimen despite the fact that there was no data in poorly adherent individuals, and even more importantly no data showing that the regimen could achieve virologic suppression in viremic patients, with all of the existing data being in those switching from a suppressive oral regimen. In fact, there is no robust clinical trial data even demonstrating that a two-drug regimen with an INSTI and NNRTI would be effective in viremic patients. While 81% suppressed on LA CAB/RPV at 48 weeks is a relatively low number compared to other regimens in viremic individuals without underlying resistance, it needs to be considered in the context that these people were generally thought to be out of options before starting this regimen.
It is noteworthy that prior to CROI 2024 the International Antiviral Society-USA (IAS-USA) guidelines, last updated summer of 2022, published an amendment stating that based upon several observational data sets, and the desperate need to help those not able to adhere to oral therapy, that a select group of viremic patients might be considered for LA CAB/RPV with close follow-up (9). The amendment to the guidelines specified that this strategy, albeit using these drugs off label could be considered in those who are followed in clinic with supportive services, who are unable to take oral therapy despite substantial effort, and have low CD4 cells or history of AIDS condition. It is important to share with patients the limited data available, as well as the risk of resistance to NNRTIs and INSTIs, which might limit options for the future. That said, the risk of emerging resistance may be justified in a select high risk patient population. Moreover, patients who would fit into this category are likely to not have resistance to boosted protease inhibitors which would be an important part of a regimen if oral agents become acceptable in the future.
Novel antiretroviral options for future
Despite the advances in oral and LA injectable antiretrovirals, this meeting did include data on new combinations and therapies that could have a substantial impact on the field.
Headlines:
• Subcutaneous lenacapavir (LEN) every 6 months plus LA CAB (with or without LA RPV) given every 1 or 2 months (10). This was open label, observational data collected from 4 sites that used this as a LA option for those who were not candidates for LA CAB/RPV alone. This included some virologically suppressed and others viremic and showed high rates of viral suppression with good tolerability.
• The ARTISTRY-1 trial administered oral LEN plus oral bictegravir (BIC) once daily in those virologically suppressed on a multi-pill regimen (11). This was a phase II study showing high rates of suppression at 24 weeks, along with good tolerability, justifying moving forward with a phase III trial.
• Oral LEN plus oral islatravir (ISL) given weekly to those virologically suppressed on standard once daily regimen was associated with high rates of viral suppression and good tolerance (12).
• New drugs with potential for once weekly dosing other than oral LEN and ISL have showed promise in phase I trials. Examples included GS-1720, a new INSTI with pharmacokinetics in healthy controls with half-life of nine days and greater than 2 log10 reduction in viral load after single oral dose (13). GS-5894 is a new nonnucleoside reverse transcriptase inhibitor (NNRTI) with activity against virus resistant to efavirenz and rilpivirine and modeled data suggested potential for once weekly dosing (14). Finally, MK-8527 is a new nucleoside reverse transcription translocation inhibitor (NRTTI) with a long half-life and early evidence of antiviral activity (15).
Study findings/Interpretation:
• Subcutaneous LEN every 6 months plus LA CAB (with or without LA RPV) given every 1 or 2 months (10). This was observational data from four sites that used this as a LA option for those who were not candidates for LA CAB/RPV alone. While an obvious next step for LA therapy would be an every 6-month option. Unfortunately, the only well studied drug with this pharmacokinetics is LEN, which is approved for highly treatment-experienced patients with multidrug resistant virus. Although there are some modified monoclonal antibodies with potential for every 6-month dosing, they are not currently available. In an effort to provide hard to treat patients' options, especially if not candidate for LA CAB/RPV alone, several centers have offered off-label therapy with every 6-month subcutaneous LEN with every 1 or 2 month LA CAB, with or without LA RPV. They reported at CROI 2024 the patient characteristics and outcomes, with the most common reason for using these regimens was having underlying resistance, particularly to NNRTIs. The group included 34 individuals, only 16 of whom were virologically suppressed at baseline. Overall, the regimen was reported to be well tolerated and suppression at variable follow-up was present in 32 of 34 (94%). It is important to note that this is observational data in a select group of patients at specific centers and therefore difficult to generalize to other sites. In addition, efficacy data is limited and there is potentially substantial risk of selecting for resistance to a capsid inhibitor, which does not have high barrier to resistance, if suppression not maintained. Finally, this is off-label use of subcutaneous LEN, LA CAB and LA RPV. No doubt, further study is needed of these novel LA regimens.
• The ARTISTRY-1 study was a phase II switch study to oral LEN 25 mg or LEN 50 mg plus oral bictegravir (BIC) (approximately n=50 participants per study arm) once daily in those virologically suppressed on a multi-pill regimen, or to continue current regimen (n=25) (11). This study showed high rates of suppression at 24 weeks in those who remained on their multi-pill regimen (100%) or switched to daily LEN plus BIC at either of the LEN doses (~96%). The goal was to allow those virologically suppressed on complex regimens to be on what can be a single tablet, two drug regimen. The most commonly used regimens at baseline were boosted protease inhibitors plus DTG and TAF/FTC or NNRTIs. The investigational regimens were highly effective and well tolerated, resulting in it moving forward in phase III where a fixed dose combination will be available. It is noteworthy that with our current understanding of therapy in those with underlying NRTI resistance, we know that a fully active second generation INSTI, e.g., BIC or DTG are likely to maintain viral suppression if given with tenofovir/emtricitabine (or lamivudine), even if there is extensive resistance to the NRTIs. As a result, BIC/FTC/TAF, recently approved by FDA for those with 3TC or FTC resistance, and considerable data showing that a fully active second generation INSTI would be effective in those with tenofovir resistance and be an alternative single tablet regimen for many.
• Oral LEN plus oral islatravir (ISL) given weekly to those stably suppressed on BIC/FTC/TAF daily to stay on regimen or switch to LEN 300 mg orally plus ISL 2 mg orally once weekly (12). Viral suppression was achieved in 96% in both study arms with no major adverse event differences. It was also noted that the mean CD4 cell counts declined in both study groups with the change being modest and greater in the control than intervention arm. This observation was reassuring since CD4 declines were a concern when higher doses of ISL were used in earlier trials. Assuming Phase III data are equally positive, this could represent the first of a new LA option that is oral and once-weekly, which could represent an important advance for patients. Of note, oral LEN and ISL are investigational so neither option, are available outside of clinical trials.
• Several new agents with pharmacokinetics that might support weekly therapy were also presented. One such agent was GS-1720, a new INSTI has pharmacokinetic and virologic data from early phase I study. GS-1720 has been shown to have half-life of 9.4 days after single oral dose of 450 mg given to healthy controls (13). Virologic data was also collected after a single oral dose of 30, 150, 450 and 900 mg, all of which showed dramatic declines in viral load over 10 days with greatest declines seen in the three highest doses ranging from 2.0 to nearly 2.5 log10 copies/mL. Study drug related AEs were uncommon and all grade 1 or 2 with no serious adverse events. This agent has shown potential for weekly oral therapy and is moving forward into phase II trials.
GS-5894 is a new nonnucleoside reverse transcriptase inhibitor which has activity against strains with resistance to efavirenz and rilpivirine (14). It was also reported to slowly select for resistant mutants in vitro and is predicted to achieve suppressive levels that would support once weekly dosing.
MK-8527 is a new NRTTI, similar to islatravir, was shown in two phase 1 single dose monotherapy studies to markedly reduce viral load with doses between 0.25 and 10 mg (15). These were small studies with 5-6 treatment naïve participants per group with mean viral load declines ranging from 1.0 to more than 1.5 log10 copies/mL with increasing doses. For reasons not completely explained, in the 1.0 mg group 2 of 5 had no virologic response. It was also stated that there was no apparent effect on lymphocyte count, as seen with higher doses of islatravir. It was further proposed that this might have some promise for prevention, a situation for which islatravir is no longer being pursued.
It remains early for each of these drugs, as well as for novel regimens, but there is increasing promise for what could be a major advance for patients, increasing LA oral regimens that may only require weekly dosing.
CROI: New HIV Therapies, Drugs at CROI 2024 - (03/11/24)
VIRAL HEPATITS AND METABOLIC-ASSOCIATED-STEATOTIC LIVER DISEASE (FATTY LIVER DISEASE)
Headlines:
• BEEHIVE Study (ACTG 5379) demonstrates superior rates of immune response in people living with HIV who failed to mount response to standard HBV vaccination when given HepB-CpG (vaccine with toll-like receptor [TLR] agonist adjuvant; HEPLISAV-B®) compared to standard HepB-alum vaccine (ENGERIX-B®) (16).
• The SLIM LIVER (A5371) is Phase IIb single-arm, pilot study demonstrated highly significant reduction in hepatic triglycerides and improvement of metabolic-associated-steatotic liver disease (MASLD) in people living with HIV (17).
Study findings/Interpretation:
• The BEEHIVE Study (ACTG 5379) enrolled people living with HIV who were eligible for HBV vaccination. A previous report included 68 individuals never vaccinated for HBV who were given two doses of HepB-CpG (HEPLISAV-B®) with 98.5% seroprotection by week 24 after second dose with 88% having HBsAb titers greater than 1000 mIU/mL. At CROI 2024 the authors reported the results of a randomized study in those who failed to previously respond to conventional HBV vaccination (16). Participants were randomized 1:1:1 to 2 doses of HepB-CpG (2-HepB-CPG) IM at weeks 0 and 4; 3 doses at weeks 0, 4 and 24 (3-HepB-CPG); or 3 doses of HepB alum (ENGERIX-B®: 20 ug recombinant HBsAg [3-HepB-alum]). Of the 505 included in primary analysis, a seroprotective response (HBsAb≥10 mIU/mL) was achieved in 93% of 2-HepB-CpG, 99% of 3-HepB-CPG and 80% of 3-HepB-alum regimen. Overall titers were higher in the 3-HepB-CpG arm than 2-HepB-CpG or 3-HepB-alum study arms. There were no major differences in adverse events between arms with most being grade 1 and 2. The study concluded that in those living with HIV with prior nonresponse to conventional HBV vaccination there was a significantly greater response to 2 or 3 doses of HepB-CPG than 3-HepB-alum dosing. The previous results, along with the current efficacy and safety findings in those living with HIV who failed to respond to previous vaccination strongly support the use of 2 or 3 dose HepB-CpG.
• The SLIM LIVER (A5371) is Phase IIb single-arm, pilot study to assess the impact a glucagon-like-peptide-1 receptor agonist (GLP-1ra) had on MRI quantified intrahepatic triglyceride content in those living with HIV who had metabolic-associated steatotic liver disease (MASLD) (17). The study enrolled adults on suppressive antiretroviral therapy with central adiposity, insulin resistance and steatotic liver disease (≥5% intrahepatic triglycerides on MRI) given semaglutide (titrated to 1 mg subcutaneously once weekly by week 4) for 24 weeks. Of the 49 participants with median age 52 years, BMI of 35 kg/m2, the treatment was well-tolerated. Mean absolute (-4.2%) and relative (-31.3%) declines were observed, and both highly statistically significant. Notably, nearly 30% had complete resolution of MASLD. The investigators concluded that low dose semaglutide is safe and effective treatment for MASLD in people living with HIV. This provides solid foundation for further studies of GLP-1ra for MASLD.
CONCLUSIONS
31st CROI 2024 was an excellent meeting, extremely well organized and presented live and virtually. There were numerous highly relevant studies related to COVID-19, HIV coinfections as well as prevention and treatment of HIV and STIs. I have focused on select studies that I thought would significantly impact the field immediately or in the near future. Readers are encouraged to look on-line for others of potential studies of interest that I did not summarize.
Conflicts: In the last 12 months Eric Daar has received research support from Gilead and ViiV and has been a consultant for Gilead, Merck, ViiV and Theratechnology.
REFERENCES
1. Luetkemeyer A, Donnell D, Cohen SE, et al. Sustained Reduction of Bacterial STIs During the DoxyPEP Study Open-Label Extension. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 125.
2. Molina J-M, Bercot B, Assoumou L, et al. Final Results of ANRS 174 DOXYVAC: A Randomized Trial to Prevent STI in MSM on PrEP. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 124.
3. Sankaran M, Glidden DV, Kohn RP, et al. Doxy-PEP Associated With Declines in Chlamydia and Syphilis in MSM and Trans Women in San Francisco. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 127.
4. Kityo CM, Mambule IK, Sokhela S, et al. Randomized Trial of Cabotegravir and Rilpivirine Long-Acting in Africa (CARES): Week 48 Results. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 122.
5. Latham C, Urbaityte R, Sutton K, et al. HIV-1 RNA Blips and Low-Level Viral Replication: SOLAR (CAB + RPV LA vs BIC/FTC/TAF. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 627.
6. Morsica G, Lolatto R, Diotallevi S, et al. Hepatitis B Reactivation in PLWH With Anti-Core Antibody After Switch to an Anti-HBV Sparing Regimen. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 737.
7. Rana AI, Bao Y, Zheng L, et al. Long-Acting Injectable CAB/RPV Is Superior to Oral ART in PWH With Adherence Challenges: ACTG A5359. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 212.
8. Hickey M, Grochowski J, Mayorga-Munoz F, et al. 24-Week Viral Suppression in Patients Starting Long-Acting CAB/RPV Without HIV Viral Suppression. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 628.
9. Sax PE, Thompson M, Saag M. Updated Treatment Recommendation on Use of Cabotegravir and Rilpivirine for People With HIV From the IAS-USA Guidelines Panel. JAMA 2024.
10. Gandhi M, Hill L, Grochowski J, et al. Case Series Examining the Long-Acting Combination of Lenacapavir and Cabotegravir: Call for a Trial. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 629.
11. Mouner K, Slim J, Ramgopal M, et al. Phase II Study of Switch to Daily BIC + LEN in Individuals on a Multitablet HIV Treatment Regimen. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 642.
12. Colson Am, Crofoot G, Ruane PJ, et al. Efficacy and Safety of Weekly Islatravir Plus Lenacapavir in PWH at 24 Weeks: A Phase II Study. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 208.
13. Fichtenbaum CJ, Berhe M, Bordon J, et al. Antiviral Activity, Safety, and Pharmacokinetics of GS-1720: A Novel weekly Oral InSTI. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 116.
14. Lansdon E, Mulato A, Jansa P, et al. Preclinical Characterization of GS-5894, a Potent NNRTI With Once-Weekly Oral Dosing Potential. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 636.
15. Russ P. Carstens1, Yash Kapoor1, Ryan Vargo1, et al. Single Dose Administration of MK-8527, a Novel nRTTI, in Adults With HIV-1. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 115.
16. Marks K, Kang M, Umbleja T, et al. HepB-CpG Vaccine Is Superior to HepB-alum in People With HIV and Prior Vaccine Nonresponse: A5379. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 209.
17. Lake JE, Kitch DW, Kantor A, et al. Semaglutide Reduces Metabolic-Associated Steatotic Liver Disease in People With HIV: The SLIM LIVER. 31st Conference on Retroviruses and Opportunistic Infections 2024, Denver, CO, Abstract 159.
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