CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

2 and 3 HCV patients with decompensated cirrhosis is daily sofosbuvir (400 mg) and weight-based RBV for up to 48 weeks. However, these patients may have lower SVR and ongoing decompensation, so careful monitoring is required.

Opening Session 5:00 pm– 7:00 pm

4AB Auditorium

Session NL1 Lecture Bernard Fields Lecture 18 Hepatitis C: Light at the End of the Tunnel Charles M. Rice The Rockefeller University, New York, NY, US

An estimated 200 million people have been infected with hepatitis C virus (HCV) with a majority unable to clear the virus. Chronic HCV infection can lead to cirrhosis, hepatocellular carcinoma, and end-stage liver disease. It is generally believed that disease results at least in part from immune mediated inflammation. Since HCV’s discovery in 1989 significant progress has been made in establishing experimental systems and unraveling the details of the virus lifecycle. Examples include viral enzyme assays, infectious molecular clones, RNA replicons and finally robust cell culture systems recapitulating the entire virus lifecycle. Definition of the human factors required for HCV entry and blunting innate immune response pathways has led to the development of a mouse model that supports HCV entry, replication and virus production. Together these tools have increased our understanding of the HCV lifecycle and revealed multiple steps for therapeutic intervention. Although painstakingly slow at times, we are finally at the cusp of a revolution in HCV treatment with the advent of well tolerated, all oral, pan genotype regimens that can achieve virologic cure rates in excess of 95%. Challenges remain but we now have the tools in hand to write the final chapter of a remarkable biomedical success story. Session NL2 Lecture N’Galy-Mann Lecture 19 Antiretroviral Therapy: Past, Present, and Future David A. Cooper Kirby Institute, University of New South Wales, Sydney, Australia Antiretroviral therapy has saved countless lives. However, we know it to be imperfect and we are always looking for ways to improve outcomes. For treatment-naïve patients, it is time either to optimise the dose of efavirenz, or replace it altogether with integrase inhibitors in combination with two nucleosides. For people requiring a second-line treatment, new studies have confirmed the current WHO standard of care but also indicated a novel approach of two new classes of drug therapy in combination, as a public health approach without the need for resistance testing. This brings us to early treatment, which is now simple, non-toxic and beneficial in reducing transmission, but about which there has been controversy in the context of insufficient resources to cover the existing number of people needing treatment.

Oral Abstracts

TUESDAY, FEBRUARY 24, 2015 Session PL-1 Plenary

4AB Auditorium

8:30 am– 9:00 am PrEP for HIV Prevention: What We Know andWhat We Need to Know for Implementation 20 PrEP for HIV Prevention: What We Know andWhat We Still Need to Know for Implementation Raphael J. Landovitz University of California Los Angeles, Los Angeles, CA, US

Tenofovir-based pre-exposure prophylaxis (PrEP) prevents HIV transmission in diverse populations. Randomized controlled trials demonstrate high levels of protection against sexually transmitted HIV for men who have sex with men (MSM) and heterosexual men and women. There are less robust data supporting the use of PrEP for prevention of parenteral transmission. Enthusiasm for widespread PrEP use is dampened by concerns about safety (both near and long term), requirements for daily or near-daily dosing, potential for viral resistance, cost, and behavioral risk compensation (increases in numbers of partners and/or less frequent condom use). Open-label “demonstration” projects are currently under way to evaluate acceptability and uptake by at-risk populations, longer-term safety, real-world adherence, the consequences of less frequent clinical evaluations, cost effectiveness, and behavioral change. Novel adherence measures will advance our understanding of patterns of PrEP dosing, coverage of sexual activity, and the optimal support mechanisms for successful PrEP use. Transitioning demonstration project participants to clinical care and an increased interest in PrEP have posed new and difficult challenges: What type of provider should be delivering PrEP services? What are the optimal locations for PrEP initiation and follow-up? What is known about sufficient and optimal dosing regimens? What will be the adverse event profile in real-world settings? Will there be increased resistance with more widespread PrEP use? How will PrEP be financed? How can we educate providers, public health bodies, and potential consumers – particularly those most at risk – about PrEP? What are the optimal HIV testing intervals and algorithms? The success thus far of tenofovir-based PrEP in both clinical trials and increasingly in clinical practice, other PrEP strategies are under active investigation. These include agents that are not nucleoside analogue reverse transcriptase inhibitors, topical and long-acting injectable formulations, as well as novel preparations of new and existing antivirals. Formidable questions remain as to how to operationalize, facilitate, and streamline PrEP access to populations most at-risk for HIV acquisition locally and globally.

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CROI 2015