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New/Optimal ARV Treatments Why ? & How
A more effective response to HIV/AIDS The Role of Value For Money New/Optimal ARV Treatments Why ? & How Pr Eric Delaporte Dr Charles Kouanfack IAS Paris 2017
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Why? Universal Access to ART
Suboptimal results whith the actual first line Low genetic barrier and increasing HIV resistance to ART ≈ 80% ≈ 60% T. Sonia Boender et al. IAS Paris 2017
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How Alternative DTG High genetic barrier Better tolerance
Cheap and simple Superior or equivalent to different first-line regimens (SPRING-1, SINGLE, FLAMINGO, SPRING-2) Safe and effective Tolerable One pill, once a day, heat stable Simple High genetic barrier to resistance Durable Few drug-drug interactions Universal Low manufacturing cost (50 mg), favorable market landscape Affordable 2015 2016 2017 DTG , TAF TAF/FTC approved Cobisistat (booster) DRV/Cobi ATV/Cobi DTG for childrens Lond drug Active: Cabotegravir, rilpirivine. Plus… IAS Paris 2017
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Benefits What is needed?
FDC of Dolutegravir (DTG)/XTC/TDF) : cheaper and better tolerate than the actual first line (generic is available) Still more cheap and better tolerate if maintenance strategy DTG/XTC is validited Less expensive second line Prevent the emergence of HIV resistance Impact on HIV monitoring? Evaluation in real-world conditions within resources-constrained settings is needed to support the recommendation of a DTG- or EFV400-based regimen as preferred first-line regimen Targeted drug-drug interaction PK studies with rifampicin (TB treatment) Additional information on safety in pregnant women Key studies:ANRS/UNITAID NAMSAL study UNITAID ADVANCE Study UNITAID DolPHIN2 IAS Paris 2017
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Thank you for your attention
IAS Paris 2017
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