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| New weapons in the raging HIV battle |
| By Jim Montalto, News Editor |
| Published: 04/30/2007 |
Maraviroc and Raltegravir may not stir emotions in many folks working inside corrections or even in facility health care units, but they did excite the Infectious Diseases in Corrections Report staff enough to include information about these two new antiretroviral agents in their coverage of the Conference on Retroviruses and Opportunistic Infections. According to April's IDCR, CROI is a premier venue to find data related to the clinical management of HIV infection.The conference is smaller and more focused than most events that discuss caring for those with HIV, but it is “data dense and always guaranteed to yield findings that influence how HIV infection is treated.” Thus, the reason Drs. Zelalem Temesgen, Associate Professor of Medicine of the Mayo Clinic College of Medicine, David Wohl, IDCR editor and Associate Professor of Medicine in the Division of Infectious Diseases, AIDS Clinical Trials Unit at the University of North Carolina, and Frederick Altice, Director of Clinical and Community Research and associate professor of medicine at Yale University School of Medicine, summarized new findings related to Maraviroc and Raltegravir. The importance of these drugs in corrections can be directly related to how vulnerable HIV-infected men and women cycling in and out of prisons and jails can be to drug resistant HIV strains due to the fact that their care can be initiated, re-initiated and interrupted during and between incarcerations. The report goes on to suggest that “infected inmates may also face a number of challenges to adherence with their HIV therapies including mental illness and substance abuse.” However, clinical trials of new antiretroviral drugs presented at CROI 2007 offered hope for multi-drug resistant HIV patients. Wohl, Altice and Temesgen write that “two new antiretroviral agents [Maraviroc and Raltegravir] that are relatively advanced in their clinical development, are currently available via expanded access programs, and may be of immediate clinical interest. These drugs represent two novel antiretroviral classes and have the potential to positively impact treatment outcomes as well as change the prevailing treatment paradigm of combining two nucleosides with a protease inhibitor or a non nucleoside reverse transcriptor inhibitor as the cornerstone of highly active antiretroviral therapy (HAART).” They then go on to discuss the details of each drug's trial and how they work. “Maraviroc (MVC) is an entry inhibitor that is a CCR5 (R5) antagonist with in vitro activity against virus that is tropic for cells that express the R5 receptor but not cells that use CXCR4 (X4) receptors or that use both types of receptors (i.e. dual tropic HIV-1). “Raltegravir, previously known as MK-0518, is an integrase inhibitor that has previously been shown to confer significant virologic benefit to antiretroviral-naïve HIV-infected patients, as well as heavily treatment-experienced patients with HIV resistant to agents in each of the three original antiretroviral drug classes.” Lopinavir/ritonavir doses and the role of directly observed therapy (DOT) are also discussed as well as the early failure of tenofovir, lamivudine (3TC) and nevirapine; how to safely dose H2 blockers with atazanavir/ritonavir; and how, through clinical trials of HIV/HCV co-infected patients, CROI challenged the idea that Hepatitis C virus (HCV) is primarily a blood-borne infection. Wohl, Altice and Temesgen say these new therapies generated excitement but suggest they are sure to come with a heavy price tag and that unresolved issues may slow interest in some of the drugs like MVC. However, “it is only a matter of time (measured in months) before the first correctional physicians will be prescribing these new agents and these issues will need to be addressed by the manufacturer of this important new agent.” To read more of the report see www.idcronline.org. |
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