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N'Galy-Mann Lecture highlights history, future of ART

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SEATTLE — The history of certain drugs, the debate over earlier treatment and the need for more people to be on treatment were the topics of the N’Galy-Mann Lecture presented here at CROI 2015.

David A. Cooper, MD, director of the Kirby Institute at the University of New South Wales in Sydney, Australia, delivered the lecture, titled “Antiretroviral Therapy: Past, Present, and Future,” during the opening session. He described the nature of HIV infections and the importance of understanding its pathogenesis and treatment.

Cooper provided an overview of the lessons learned from ART drugs, focusing specifically on Sustiva (efavirenz, Bristol-Myers Squibb), its importance and role in HIV treatment, and how to best optimize the drug’s use. From a global perspective, Cooper speculated on improvements to the universal regimen recommended by WHO.

Cooper also discussed the need for strategy trials, particularly for early treatment — a “hotly debated” subject.

“I don’t want to come down on one side or the other as I understand the arguments for both,” Cooper said. “But there are important issues to highlight in terms of the personal benefit of ART for those that don’t have serious immune deficiency vs. the public health benefit of prevention of transmission.”

Lastly, Cooper discussed the global rollout of ART. As of June 2014, 13.6 million people are on ART globally. When measuring by WHO guidelines of starting ART at CD4 counts of less than 500 cells/mm3, this number needs to increase to at least 22 million patients.

“As funding from the PEPFAR and from the Global Fund have flatlined, there is an urgent need to make sure we can achieve the 90-90-90 by 2020 goal set by UNAIDS,” Cooper said. “By 2020, 90% of people with HIV will know they’re infected, 90% of those will be on treatment, and 90% of those will achieve viral suppression.” – by Emily Shafer

Reference:

Cooper DA. Antiretroviral Therapy: Past, Present, and Future. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.

Disclosure: Cooper reports financial relationships with Gilead Sciences, Merck and ViiV Healthcare.