July 29, 2019

Research Roundup: WHO recommends dolutegravir as the first-choice HIV treatment, an arm implant that may one day protect against HIV, and malaria drugs failing in Southeast Asia

Ansley Kahn
Senior Program Assistant
PATH/Carib Nelson

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The World Health Organization (WHO) has changed its guidelines to strongly recommend the antiretroviral medication dolutegravir (DTG) as the preferred first- and second-line treatment for all people living with HIV, including pregnant women. Last year, many countries advised pregnant women, or those who might become pregnant, to take efavirenz (EFV) instead of DTG after a study in Botswana found a possible link between DTG and serious birth defects in newborns. Presenting new research from the ongoing study at the International AIDS Society Conference on HIV Science, WHO stated that the potential risk for birth defects was significantly lower than previously estimated, with benefits for women outweighing drawbacks.

Preliminary testing of an implant containing a new antiretroviral drug, islatravir, in a dozen patients over 12 weeks suggests that it may protect against HIV infection for a full year. The implant, a matchstick-sized plastic rod inserted just under the skin of the upper arm, slowly releases tiny doses of islatravir, which lingers in the body for a relatively long time so it can be given less than other medications. Unlike some other HIV drugs, islatravir is absorbed into the anal and genital tissues where most infections start and is less likely to give rise to drug-resistant strains since it attacks a different stage in the infection process. The implant could help those at risk of HIV infection, particularly women in Africa, who are looking for prevention methods that are easier to use and conceal. Large clinical testing is required to determine the safety and efficacy of this implant in protecting against HIV infection.

Malaria drugs are failing at an alarming rate in Southeast Asia as drug-resistant strains of the disease emerge, according to two new reports released in The Lancet—prompting global concern that this drug resistance could spread around the world. One of the studies, performed in the greater Mekong region, compared a new three-drug malaria regimen against the conventional two-drug artemisinin combo—used to treat the majority of malaria cases—when researchers noticed the antimalarial drugs in the current regimen weren’t fully wiping out the deadly parasites. The overall failure rate was 50 percent, but in some parts of the region the drugs weren’t working nine times out of ten. If drug resistance to first-line malaria drugs continues to spread, it could mean major setbacks to the global effort to control the mosquito-borne disease.