France on the road to treatment 4 days a week

Most HIV-positive people in France take daily treatment for life. But the possibility of easing this constraint soon is emerging for patients on triple therapy, the Conversation reports. A major trial began in September to confirm, in the continuation of a smaller trial, that patients can skip several days of treatment in the week without risking their health.

In France, some 300 patients have already switched to a "intermittent short-cycle" treatment method. For years, they have taken their medication four days a week, instead of the seven days provided in the official protocol. And they are doing well.

The new test, dubbed Quatuor, was launched by ANRS, the French Agency for Research on HIV / AIDS and Viral Hepatitis. It aims to show that there is a benefit for the patient to take his triple therapy only four days out of seven. 640 volunteers are being recruited in the 65 public hospitals in France. The principal investigator of this trial is dr. Pierre de Truchis, infectiologist at Raymond Poincaré Hospital in Garches.

The main experiment is conducted since 2003 as part of a protocol called Iccarre. This program was initiated by Dr. Jacques Leibowitch. Patients followed by Dr. Leibowitch and his colleagues at the Raymond Poincaré Hospital have thus gone from seven to five days treatment, then to four. In spite of this, their viral load remained below the detection level. These results for 48 patients were considered sufficiently robust by the international scientific community to be published in the journal Faseb Journal in 2010. The same experiment led to a second publication in 2015, with a greater number of patients (94, precisely) and more years of hindsight.

Convinced by the first results of the Iccarre protocol, the ANRS launched in 2014 a two-year clinical trial conducted in 17 centers in France, called 4D (4 days). The findings were presented at the 2016 International AIDS Conference in Durban, South Africa. They indicate that 96 of 100 patients in the trial followed the dosing regimen with four consecutive days out of seven successfully. 3 patients had a new detectable viral load by the fourth week of the study. It has become undetectable again, with the return to a daily treatment regimen. 1 patient left the study.

The results encouraged the ANRS to continue in this direction with the Quatuor test. "Quatuor seeks to demonstrate that the 4/7 strategy is inferior to the 7/7 strategy, it has equal effectiveness. Patients will derive secondary benefits from this protocol, less side effects, better commitment to treatment etc.”, said the ANRS on its website.

Simplification of treatment use is designed to lower rates of side effects and treatment costs, and to improve acceptability and adherence. It is important for people living with HIV, whose antiretroviral therapy is lifelong. This is why it is being studied in several trials worldwide.