Perspectives on unmet needs in HIV management and treatment

Stephen Peskin, MD, MBA, FACP: It is almost universally true that every state has unmet needs. in the realm of HIV [human immunodeficiency virus], we would like to vaccinate. The National Institutes of Health is pushing this forward, and both the National Institute of Allergy and Infectious Diseases and extramural grants to academic institutions are trying to address this. Another unmet need, as we’ve talked about before, is the concept of better coordination of care, managing the complications of HIV, sometimes the disease itself, sometimes medicine. Again, we’re not perfect when it comes to frequency of viral load testing. Perhaps an early warning signal for the re-emergence of infections. These are unmet needs. Think a bit futuristically, if someone has some sort of nanotechnology that is circulating and harmless enough to signal patients and their clinical teams, giving them an earlier indication that treatment has begun. Whether there is something… flinch. But again, at the top of the list of unmet needs would be vaccines.

Eugene McRae, M.D.: I believe the greatest unmet need is the development of therapeutics that allow convenient dosing schedules, do not require strict adherence to diet-related timing restrictions, and can remain active in the face of resistance mutations. , for treatment-experienced patients whose HIV has acquired resistance to two or more drugs. There are very few new drugs for these individuals. A major concern we have is the rapid development of resistance in those populations. Or in the treatment of patients without multiple drug resistance.

I think the other thing is to recognize that there are other cofactors that cause patients to develop multidrug resistance and to address some of those cofactors. Like I said earlier, dealing with homelessness, substance abuse, and other situations of drug use. These are unmet needs that may have a real impact on treatment and outcomes for patients with drug-resistant HIV.

How will HIV treatment change in the future? A lot of interesting things are happening. First, we have the long-acting injectables that we talked about earlier, the 6-month and 12-month regimens. This is very exciting and we anticipate approval of one or more regimens of 6- or 12-month long-acting injectables within the next year or so. Another thing that isn’t talked about much is long-lasting implants. These are 12-month implants that slowly deliver one or more powerful antiretroviral drugs, similar to those used for birth control. It is being investigated for pre-prophylaxis and for HIV treatment. Several of these clinical trials are ongoing and we think they are very promising and will be another tool in the toolbox for treating and preventing acquired MDR. [multidrug resistant HIV].

But the most exciting thing for me is to use mRNA to develop an effective HIV vaccine. [messenger ribonucleic acid] Technology used for the COVID-19 vaccine. HIV vaccine development is really gaining momentum and will be significantly accelerated by 2022 with candidate vaccines utilizing this mRNA technology. There are at least three or more products out there, some of which have shown very promising results. So vaccines using mRNA technology are probably what I’m most excited about. And for the first time in years, it looks promising.

Stephen Peskin, MD, MBA, FACP: Looking ahead to the next three to five years for HIV treatment, there is a continuing need to strengthen health literacy, especially for people living with HIV. I have seen examples in the HIV community, and especially in the gay male community, of a strong awareness of and in some ways support for this condition. But in other groups, not so much. People who contracted HIV through heterosexual activity tend to be less insightful. The use of self-monitoring is important. People can self-monitor from the comfort of their own apartment, home, or flat and provide that information to trained clinicians to act appropriately.

We talked a little bit about using telemedicine. For most chronic diseases, we believe telemedicine represents a significant opportunity to expand care teams. We talk about the importance of the care team, it’s part of the present, but it’s also part of the future of healthcare. place. We see it in all areas, but HIV is certainly part of the future as well. Again, part of the future over the next three to five years will be the continued development of new therapies, new therapies, to address multidrug-resistant HIV. It also makes it easier for patients to treat themselves with highly active antiretroviral therapy, as is done with some oral medicines that contain multiple drugs in one pill.

HIV is one of the most observable diseases and is critical to health planning.From the early days, I remember when AZT [azidothymidine] was introduced for the first time. Sounds like ancient history. I worked for medical insurance in Boston, Massachusetts, and there was a great deal of concern that AZT would be the end of the health insurance system. Of course it’s ridiculous. But looking back now, fortunately, it has become a chronic disease. I am committed to improving and continuing to improve what health plans and payer communities working in tandem with clinical systems, ecosystems, and their geographies have already won for health care in the United States and around the world. I think we are working on it. From 1 year to death sentence that he is a chronic medical condition within 2 years.

Edited transcript for clarity.