Search for New Drugs in HIV/AIDS Clinical Care

Several industry-supported studies provide information on new drugs in various stages of development, including the PIs tipranavir, TMC-114, and 908 (the amprenavir prodrug), and the NRTI SPD754.

CCR5 antagonists created quite a buzz at IAS: Several are entering phase III trials and could be available in the next 2 to 3 years.

CROI 2012 featured 96-week data on dolutegravir and dose-ranging data for the tenofovir prodrug GS-7340.

But does it matter as much as we once thought?

The newly approved HCV protease inhibitors boceprevir and telaprevir promise to revolutionize HCV treatment.

Nearly half of the patients with triple-class resistance who added raltegravir to their optimized background regimens had viral loads <50 copies/mL at 96 weeks.

The latest guidelines include updated information on resistance to both old and new drugs and provide specific recommendations for the clinical application of resistance testing.

Data presented at the 15th Retrovirus Conference highlighted the importance of strengthening airborne infection-control practice and relying less on hospital TB care, particularly in resource-limited settings.

In a large study of patients with CD4 counts <200 cells/mm3, the risk for a new AIDS-defining event was 22% lower during periods of virologic failure on ART than during treatment interruptions.

A perspective on the year’s most important stories in HIV medicine

The latest guidelines include new recommendations on resistance testing, earlier initiation of therapy, and use of HLA B*5701 testing in patients considering abacavir.

Because raltegravir inhibits a novel viral target, even HIV that is resistant to other antiretroviral-medication classes is sensitive to this drug.

In a retrospective analysis, salvage regimens that contained two full-dose PIs plus ritonavir had similar virologic efficacy to those that contained one boosted PI.

In a U.K.-based cohort study, viral rebound rates fell over time among patients achieving plasma HIV RNA levels ≤50 copies/mL; after 4 years of continuous suppression, rates were similar in patients with and without a history of treatment failure.

Raltegravir (the first integrase inhibitor) and maraviroc (the first CCR5 inhibitor) are both effective and well tolerated in highly treatment-experienced patients.

Initial concerns that antiretroviral therapy would be less effective in resource-poor settings ― or that patients there would be less adherent ― appear to be unfounded.

Even triple-class–experienced patients can achieve virologic suppression with some of the new agents now available.

Results were promising with this pyrophosphate analogue, but the availability of newer drugs in other classes might obviate the need to use foscarnet as salvage therapy.

Patients starting potent antiretroviral therapy in low-income countries have similar rates of virologic suppression and immunologic recovery as patients in high-income counties, but they still have higher initial mortality rates.

Two new studies suggest that 10% of treatment-naive patients in Europe — and 20% of treated patients in the U.K. specifically — have resistance to HIV drugs.