HIV Prevention and Treatment Data From AIDS 2022

Key Takeaways:

• AIDS 2022 prevention studies of interest found doxycycline to be effective against sexually transmitted infections when used as postexposure prophylaxis for people with HIV and those receiving pre-exposure prophylaxis (PrEP), confirmed the superiority of long-acting cabotegravir vs emtricitabine/tenofovir disoproxil fumarate as HIV PrEP for cisgender women, and highlighted the inequities in access to HIV PrEP in the United States.
• AIDS 2022 treatment studies of interest found tenofovir alafenamide and tenofovir disoproxil fumarate to be noninferior regarding HIV suppression in patients coinfected with HIV/hepatitis B virus but that more patients achieved hepatitis B suppression with tenofovir alafenamide, and further follow-up confirmed the safety of dolutegravir in pregnancy.

The 24th International AIDS Conference (AIDS 2022) took place recently in Montreal, Canada. The conference was last held in Montreal in 1989—and enormous progress has been made in the 33 years since then. In this commentary, I’d like to highlight a few of the many interesting abstracts presented that may impact my own clinical practice.

Prevention Studies

Doxycycline for STI Postexposure Prophylaxis
Luetkemeyer and colleagues presented results of the DoxyPEP study, which tested the efficacy of doxycycline taken within 72 hours of condomless sex in preventing acquisition of sexually transmitted infections (STIs) among men who have sex with men and transgender women.

This randomized, open-label, controlled trial found that doxycycline reduced the risk of STIs (including chlamydia, gonorrhea, and syphilis) by approximately 65% overall. Results were comparable in people without HIV receiving pre-exposure prophylaxis (PrEP) and people with HIV. Rates of tetracycline resistance among gonorrhea isolates available for testing were comparable to background rates in the United States (~20%). These data suggest doxycycline can be another effective measure for preventing STIs in those at risk.

FTC/TDF vs LA CAB for PrEP in Cisgender Women
Delaney-Moretlwe and colleagues presented results of the open-label phase of HPTN 084, which compared the efficacy of daily oral emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) with every-8-week injectable long-acting (LA) cabotegravir (CAB) as PrEP in cisgender women.

LA CAB demonstrated continued superiority overall vs daily oral FTC/TDF, with only 3 new infections occurring in the LA CAB arm vs 20 in the FTC/TDF arm. No new safety concerns emerged, including among women who became pregnant during the study. These data confirm the long-term efficacy of LA CAB for HIV prevention in cisgender women. 

Equity Access to PrEP
Lastly, Sullivan and colleagues provided evidence of striking inequities in PrEP uptake across the United States. Sullivan defined the PrEP-to-need ratio (PnR) as the number of PrEP users in a group divided by the number of new diagnoses in that group in the same year.

The PnR was highest in the Northeast United States and lowest in the South; intermediate ratios were found in the Midwest and West. In all regions, the PnR was substantially greater for White patients than for Black or Hispanic patients, highlighting the need to provide PrEP to communities and people at greatest risk of HIV infection. These findings reinforce the importance of striving for equity in access to PrEP.

Treatment Studies

Bictegravir/FTC/TAF vs DTG Plus FTC/TDF in Persons With HIV and HBV Coinfection
The ALLIANCE group presented Week 48 results of a randomized trial that compared the efficacy of bictegravir/FTC/tenofovir alafenamide (TAF) vs dolutegravir (DTG) plus FTC/TDF in suppressing hepatitis B virus (HBV) viremia in adults with both HIV and HBV.

Although both regimens were similarly effective in suppressing HIV, a greater number of patients achieved HBV suppression while receiving TAF vs TDF (63% vs 43%; P = .023). This result is surprising, because studies in people with HBV alone demonstrated noninferiority of TAF vs TDF and because the rate of HBV viral load decline was similar in both arms of the study.

Of note, a somewhat greater number of participants in the TDF arm had HBV viral loads >10⁸ IU/mL and were hepatitis B e antigen positive compared with the TAF arm and thus may require more time to become undetectable. It will be important to see if these differences persist at Week 96. If confirmed, these data could lead to a significant change in how HBV is treated in people with both HBV and HIV.  

New Data from Tsepamo Study on DTG in Early Pregnancy
Additional reassurance regarding the safety of periconception DTG was provided by Zash and colleagues. Further follow-up of the Tsepamo study in Botswana showed that rates of neural tube defects were no different in babies of women who received periconception DTG vs those who received other antiretroviral therapy (0.11%). These data provide additional reassurance regarding the safety of DTG in all stages of pregnancy and in people who might become pregnant while receiving DTG.

Your Thoughts?
Did you follow AIDS 2022? What are your thoughts about new and interesting data? Join the conversation by adding a comment or question.