What Is the Most Important HIV Development of 2005?

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The Body Covers: The 45th Interscience Conference on Antimicrobial Agents and Chemotherapy

What Is the Most Important HIV Development of 2005?

December 19, 2005

While covering the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, D.C., from Dec. 16-19, we asked a range of attendees what they felt was the most significant development in the world of HIV in 2005 -- and to offer their thoughts on what 2006 may hold in store. Here is what they had to say. Ward, M.D., Dupont Circle Physicians Group, Washington, D.C.There really isn't much earth-shattering news in 2005 in terms of HIV treatment. … The biggest issue by far are the cutbacks in Medicaid ( White, Medicare, etc.) that will have a dramatic impact on the ability to provide care to those who need it the most and that are trickling down even to those with good insurance. I fear that this is just a preview of what the current administration and Congress have in store for health care in general. Lionel Piroth, M.D., Hôpital du Bocage, Dijon, FranceI don’t see a lot of clear data on new drugs, so I think we should refocus on new ways in which to use the resources we have. We need to think long term, for example, experimenting with withdrawal interruptions, new medication sequencing and a la carte options for patients. In the late 90s we were all thinking in the short term, focusing on viral load, cost and side effects. We should shift to long-term strategies for helping individual patients succeed -- thinking outside the box about what can be done with current meds. We still need to work on HIV prevention and adherence, especially with men who have sex with men. Increased life expectancy should be our main goal, and we can’t get there without redoubling our prevention efforts and rethinking our treatment strategies. Mark Mascolini, National AIDS Treatment Advocacy Project, New York CityAntiretrovirals are my specialty. There have been lots of clinical trials involving new PIs (protease inhibitors) and NNRTIs (non-nucleoside reverse transcriptase inhibitors) that control replication in resistant patients. Until the past year, there was a lot of cross resistance with antiretroviral therapy; now people are responding positively to new agents. This is the result of a lot of hard work and research. n Larder, Ph.D., Response Database Initiative, London, United KingdomI was at the European AIDS Conference in Dublin, Ireland, this year, where a small study on integrase inhibitors was presented. These experimental drugs are having potent effects at an early stage. The study may come to fruition in a few years. Anonymous VirologistThe new CCR5 inhibitors held a lot of promise, and that is now in question: GlaxoKline’s aplaviroc went down, because it was, only rarely, associated with severe hepatotoxicity; Schering-Plough’s vicriviroc phase II trial was halted, because the drug wasn’t measuring up to Combivir (zidovudine/lamivudine, AZT/3TC) + efavirenz (EFV, Sustiva, Stocrin) in treatment-naive patients; there’s still hope for Pfizer’s maraviroc. At this point the entire sub-class may show safety concerns, though. I’d say CCR5 inhibitors aren’t dead yet, just in intensive care. The other big question of the year is whether it’s possible to effectively sequence NNRTIs. Capravirine didn’t help NNRTI-experienced patients. TMC125 is still in development, but it does not look promising. Patients want to know whether they can go from first-line efavirenz to another NNRTI without developing resistance. It was really a year of semi-negatives and questions, rather than a year of hope or answers. Kantor, Stock Analyst, RBC Capital MarketsThe Comet Study was presented at ICAAC 2005 this weekend, which I find fascinating. It looked at switching people who were stable on their first-line regimen: it put them on another regimen, even though the first one worked fine. The outcome was positive: the patients’ viral loads dropped. They were more successful when switched to the second treatment than when they maintained the first. This is a thought-provoking new development. For the last few years, there haven’t really been any big developments in HIV medicine, but there’s a lot in the pipeline, so 2006 will probably be a big year for new drugs. M.J., Research TechnicianThe most significant thing that happened in the world of HIV this year was the failure of the World Health Organization’s 3 by 5 Initiative to treat three million HIV-infected people with antiretroviral drugs by 2005. , PhysicianDevelopment of new meds was the most exciting thing that happened for HIV in 2005: TMC114 is an interesting new PI; CCR5 inhibitors may or may not come to fruition; TMC125, a new NNRTI, also called etravirine, is questionable. We really need more drugs, more classes … anything that addresses resistance and adherence. Patients have a hard time understanding the importance of regimen adherence and the threat posed by drug resistance -- life gets in the way of treatment adherence. Treatment-experienced patients need more options, especially patients on salvage therapy. Anonymous Pharmaceutical Company RepresentativeResearch into new drug classes and sub-classes is the best thing that came out of 2005. It would be wonderful if we could find a class that didn’t result in drug resistance. Until then, we will constantly have to find new drugs, because patients will keep getting resistant and they’ll need new options.

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