The Covid-19 pandemic has profoundly affected the tests and treatments of other infectious diseases, such as the human immunodeficiency virus (HIV).

As most countries are overburdened by efforts to test and treat Covid-19, the pandemic has compromised the abilities of medical institutions and other service providers to prevent, test, and treat these infections, according to medical professionals.

Diagnosing and taking care of people with HIV had been critical challenges globally before the Covid-19 outbreak. It has become even more critical to understand how this global crisis has affected detecting and curing HIV patients and how to mitigate its effects on responses to the epidemic.

Against this backdrop, Korea Biomedical Review met with Caroline Choi, head of Gilead Science's Asia 5 (Korea, Taiwan, Hong Kong, Singapore, Malaysia) Medical Affairs.

a top official of the leading developer of antiretroviral therapy for HIV, Choi expressed strong confidence in the potential of Biktarvy, which greeted the third anniversary of market launch this year, in switching other HIV treatments.

Question: It's been over a year that you took this position as the head of Gilead Science's Asia 5 Medical Affairs. What are your strategic priorities after taking office, and what have you achieved?

Answer: Taking charge of the medical affairs for five Asian countries has not been easy amid the ongoing Covid-19 pandemic. However, I am pleased to have contributed to improving Asian patients’ health by studying their disease profiles.

It has been a decade since Gilead Science entered the Asian market. Looking back over the past decade, we have contributed to a wide variety of medical areas.

However, there is still much more we can achieve.

Asia is a region with great potential in many respects, and the region has many good researchers and medical staff.

Therefore, I think Gilead has many opportunities to come up with the most optimal solution for unmet needs by taking a patient-centered and evidence-based approach.

Gilead is constantly asking key questions and trying to understand the challenges of patients better so that we can develop further in Asia.

Also, the company is working to create various opportunities so that many patients receive diagnoses and treatment promptly, along with improved awareness in the areas of HIV, hepatitis B, and hepatitis C.

Gilead's mission is to research, develop and supply innovative therapeutics to overcome fatal diseases. We will continue to provide good treatment options by standing at the center of patients in Korea and other Asian regions.

As part of such goals, the company's internal goal includes launching 10 transformative medicines by 2030.

Q: Due to the recent Covid-19 pandemic, patients are having a hard time visiting medical institutions, which might have affected the diagnosis and treatment of HIV patients. What is the impact of Covid-19 in the Asia-Pacific region regarding HIV treatment? What plans does Gilead have to overcome this crisis?

A: There are indeed concerns in terms of HIV management due to the prolonged Covid-19 outbreak.

The International AIDS Society President Dr. Adeeba Kamarulzaman said that Covid-19 severely reduces access to HIV-related healthcare across all countries, regardless of income.

Dr. Kamarulzaman stressed that this might also increase the risk of health complications and urged countries to prepare for potential public health emergencies in the future.

Last year, we also conducted an online survey of HIV-infected people, non-infected people with a high risk of HIV, and medical workers in 10 Asian countries.

As a result of the survey, the company confirmed that surveyors felt confused or uncomfortable about HIV testing, medical advice, or access to treatment.

Also, the HIV screening rate has decreased significantly in other countries, and Korea has suspended most HIV screening tests at public health centers due to the Covid-19 virus.

We do not believe it is a problem that this company can solve by itself. Therefore, we have constantly cooperated with stakeholders and have introduced various measures, such as sponsoring HIV-related projects by non-profit organizations and providing counseling for infected people.

Q: The Covid-19 has also had an impact on pharmaceutical companies conducting global clinical trials. Has this affected Gilead conducting trials in the HIV sector in Asia, and how is the company preparing for this matter?

A: Regarding Covid-19's impact on clinical trials, I would like to introduce one of the clinical studies currently underway at Gilead Science, the Real-World BICSTaR Study.

The study aims to collect the efficacy, safety, and patient-reported outcome (PRO) data from patients receiving Biktarvy in Korea, Taiwan, and Singapore.

While there are some difficulties in conducting clinical trials because the rate of new patients being screened and transferred to the hospital has declined, the company and hospital medical workers communicate very closely.

We are making the most of non-face-to-face meetings and working hard to get support from the head office staff to prevent setbacks.

Q: Since you mentioned the clinical trial for Biktarvy, data show that Biktarvy is playing a big role in HIV treatment globally. How would you rate Biktarvy's performance?

A: Biktarvy (Ingredient: bictegravir, emtricitabine, and tenofovir alafenamide) recorded 8 trillion won ($6.7 billion) in global sales last year and ranked first in market share in the HIV treatment market.

Such sales records suggest that Biktarvy will become the fourth best-selling drug in the world in 2026, and we are very proud that Biktarvy has established itself as a treatment that has helped many people living with HIV.

When we collected the opinions of the medical professionals who prescribed Biktarvy, most stressed that the virus suppression effect and safety that the company confirmed in the clinical trial results are also shown in the medical fields.

Also, as Biktarvy is a small single-tablet combination that can be taken with or without a meal, patients gave a lot of feedback that it is a good drug to take.

Q: Gilead's differentiated marketing also seems to have played a role in Biktarvy achieving good results in the market quickly. How does Gilead market Biktarvy differently from other HIV treatments?

A: Gilead is a company that develops innovative therapeutics. As a result, we conduct evidence-based marketing with clinical significance through numerous clinical studies and data construction.

This seems to be the reason why Biktarvy grew as a globally leading drug.

Regarding the drug itself, the most recently developed integrase strand transfer inhibitor (INSTI) drug bictegravir, one of the three components that make up Biktarvy, is unique.

It has a structure in which two rings are combined to bind strongly to the integrase and have a very long half-life of 17 hours.

According to the company's data, the fact that the resistance barrier has a very high characteristic seems to be one of the secrets behind our successful marketing.

Biktarvy pill’s mall size and administrative convenience regardless of meals are big advantages as it is not easy to take HIV treatments at a certain time every day.

Also, Biktarvy has another great advantage as patients can receive treatment without additional confirmation of preliminary tests once diagnosed with HIV.

Such benefits have allowed Biktarvy to become a drug considered first in various guidelines in most countries.

Q: As the head of the five Asian countries, what are your plans for HIV treatment?

A: Ultimately, the goal is to establish Biktarvy as a good treatment option so that HIV patients in Asia can maintain their quality of life.

The company will continue to build long-term clinical data in various patient groups in Biktarvy alone to achieve such goals.

The company has also established a website called "HIV ASIA," where medical professionals can obtain the latest information on HIV treatment.

Gilead also has a portfolio capable of pre-exposure prophylaxis (PrEP) called Truvada, a drug used for people negative in HIV-1 infection but at high risk due to sex with an HIV-positive partner.

We want to make efforts to reduce the number of new infections and improve awareness.

As this is not something the company can do alone, we plan to collaborate with researchers, medical staff, various organizations, and government agencies.

Q: You mentioned improving awareness. Among the countries that you oversee, which country has the best awareness toward treating HIV?

A: Among the regions I am currently in charge of, I think Taiwan is the most advanced and far ahead in resolving social prejudice.

The country has already met the World Health Organization's 90-90-90 strategy, which aims to diagnose 90 percent of HIV-infected individuals, put 90 percent of them on antiretroviral therapy, and achieve virologic suppression in 90 percent of them.

We actively partner with the LGBTQ community, such as holding a parade with Taiwan's Pride Alliance. In addition, Taiwanese researchers and medical workers are very active in eliminating social prejudice.

In Korea, we partner with infectious disease doctors and community groups, and these doctors are very patient-centered and care a lot about patients.

Although there may be differences in social prejudice compared to Taiwan, we expect that Korea will soon establish an environment where anyone can receive diagnosis and treatment without prejudice.

Gilead is also thinking a lot about improving the perception of HIV in Korea and is planning various support programs.

An example would be Gilead Asia Pacific Rainbow Grant, a project that sponsors non-profit organizations for HIV prevention and social prejudice topics.

After kicking off the project in 2018, the company has supported disease information awareness improvement education through 60 projects with about 54 local groups.

Q: Aside from HIV treatment, what areas is Gilead Science focusing on?

A: We are recently expanding our portfolio to the anticancer field.

Last year, Gilead expanded its cancer treatment portfolio by acquiring Forty-Seven, specializing in anticancer drugs, and Immunomedics, which develops antibody-drug conjugates (ADCs).

The company has acquired Trodelvy, a breast cancer treatment, and Magrolimab, a blood cancer treatment substance, through taking over Immunomedics and Forty Seven.

Also, Kite Pharma, a subsidiary of Gilead Science, recently opened a regional hub in Singapore, following the U.S. and Europe.

We are coming up with ways to introduce the drug to Asia, including Korea, from various angles.

While it is too early to provide any information regarding the release of anticancer drugs in Asia, we have very high expectations.

Q: What role will the Asia region play in Gilead's goals of expanding its anticancer pipeline?

A: As Gilead is looking at active partnering and acquisitions concerning other pharmaceuticals, there will be many opportunities for collaboration in Asia.

I think it would be great for Asian researchers to collaborate in such studies, and it would be great if the Asian branch of Gilead Science could play a vital role in launching such treatments in the future.

Q: What are your plans moving forward?

A: Gilead's core treatment areas are HIV, hepatitis B, and hepatitis C. Although we already have a good portfolio, there remain many cases where patients cannot receive diagnosis or treatment due to various factors depending on the country, even though they need treatment.

The short-term goal is to examine where those gaps are and enable patients to receive good treatment promptly through research opportunities or partnerships with external organizations.

I am constantly thinking about how to find and bring better solutions to Asia.

Asia, including Korea, has very good researchers, medical professionals, and medical technology. I want to contribute to finding a win-win situation where academic, patient care and drug development effectively combine.