The Conference on Retroviruses and Opportunistic Infections (CROI) in the US and the International AIDS Society (IAS) conference elsewhere are two of the most important annual HIV science gatherings each year. This year’s meetings, held in Los Angeles and Sydney Australia, included literally thousands of posters and presentations, on topics spanning the HIV science spectrum, from antiretrovirals to opportunistic infections and microbicides. This issue of PI Perspective will cover some of the most important stories from this year’s meetings, from new anti-HIV drugs, new research on older anti-HIV drugs as well as areas like cardiovascular disease and lipodystrophy.
On the day the announcement went out that the Food and Drug Administration had approved the new oral entry inhibitor Selzentry (maraviroc), the price was announced at $29 per day or $10,585 per year. Whether this sounded like a lot or about average depended in what country you live and what you know about drug pricing. Without knowing what other drugs cost, it would be difficult to understand what it meant at all. The purpose of this article is to share some of the background on drug pricing and community efforts to put a lid on the price of new drugs.
Researchers, doctors and treatment activists often use the term pipeline to refer to the collection of all experimental HIV drugs currently being developed. The 2007 Conference on Retroviruses and Opportunistic Infections (CROI), held in Los Angeles and the International AIDS Society Conference on HIV Pathogenesis Treatment and Prevention (IAS), held in Sydney, Australia, were full of presentations on drugs currently moving through this pipeline. This article reviews some of the most important or interesting presentations in the antiretroviral pipeline.
Influenza, or simply the flu, is a serious respiratory infection that makes hundreds of thousands of Americans ill each year. It can cause many complications for people with damaged immune systems, including people living with HIV. Despite improved prevention and treatment, the flu still causes 36,000 deaths in the US each year. This publication provides an overview of the disease with a focus on preventing the illness.
As reported in the April 2007 issue of the journal, AIDS, a study examining the use of Reyataz (atazanavir) as monotherapy was stopped early due to high rate of virologic breakthrough. The researchers planned to study 30 people, with undetectable HIV for at least one year on conventional HAART. They would be switched from their regimen to a once-a-day regimen of 300mg of Reyataz + 100mg of Norvir (ritonavir). The study was halted after 15 people were recruited because there were 5 cases of rebounding HIV levels. The five cases of viral rebound happened between 12 and 16 weeks after starting Reyataz monotherapy.
A study published in the April 2007 issue of the journal AIDS found treatment interruptions to be safe in people who began anti-HIV drug treatment for the first time when their CD4 counts were above 350. This finding is at odds with other studies of treatment interruptions—most notably the SMART study, but also PART, DART and TRIVICAN—which all found treatment interruptions to be risky. The difference may be due to the groups of people being studied.
While specific drugs have fallen in and out of favor, the basic structure of anti-HIV therapy—called HAART—has changed very little since the late 1990s. Almost all regimens include one highly potent drug—either a boosted protease inhibitor (PI) or an NNRTI—along with two NRTIs. While there’s no doubt that this has proven very successful, it comes with many side effects associated with taking two NRTIs. As two new important classes of drugs launch onto the market, it may now be the time to begin questioning the conventional wisdom of HAART. One area that seems most ripe for it is the widespread use of NRTIs (nucleoside/nucleotide analog reverse transcriptase inhibitors).
The year 2007 is shaping up to be a busy one for anti-HIV drug development. By year’s end at least two and possibly three new anti-HIV drugs will be approved. It’s not only the number of new drugs that is significant. Two of them—maraviroc and raltegravir—will be the first of their types to gain FDA approval. The third drug, etravirine, represents a much needed second chance for many people whose virus has become resistant to an entire class of drugs. This article reviews these three drugs, focusing on how each differs from the current drugs and how it may fit strategically into the treatment of HIV.
One of the most important details when taking a new medication is how safe it is. The US Food & Drug Administration (FDA) collects this information in many different ways, including from individuals who use the medicines or medical products. By doing so, the FDA can identify possible problems, especially when medicines enter expanded access programs (EAPs) and reach more people.
Since the early days of the AIDS pandemic, much of the focus has settled on the effect that the disease had on the young. When previously healthy, young adult gay men began showing up in hospitals around the country with a baffling, and usually fatal new disease, the tragedy of life lost early was palpable. When the disease soon appeared in newborns and children, even those unsympathetic to the plight of gay men felt the sting of HIV. While this sad dynamic remains all too real today in many areas of the world, a different HIV infected population is growing more prominent throughout the developed world—older people living with HIV.
So, you take care of your mind, body, and whatever else is in need of maintenance, and you time your meds by the bleep of the atomic clock and never miss a dose. Good for you. Who would think that going to the hospital for your face-lift or appendectomy or brain transplant could be a threat to all of that hard work and discipline.
This information is designed to support, not replace, the relationship that exists between you and your doctor.