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how many on the horizon
Jul 8, 2003

How many drugs are in the pipeline for resistant virus that look promising to you??

Response from Dr. Pierone

There are some very promising HIV medications on the horizon for resistant virus. One that is actually available now is T20, or enfuvirtide, or Fuzeon. This is the first of a new class of medications, fusion inhibitors, which block entry of HIV into cells and thereby prevent infection. It is given by injection twice daily and aside from causing red knots at the injection site is well tolerated. Since it is in a completely new class it works well against drug-resistant virus and produces about a 10-fold decline in HIV levels in the blood. It works best with 2 other active agents to complete a cocktail, but does have meaningful activity even when it is the only drug that virus is sensitive to.

Another very promising medication in phase 3 testing is Tipranavir. This protease inhibitor is active against HIV virus that is resistant to all other protease inhibitors. It needs to be boosted with Norvir and is given twice daily. It will become available on expanded access (on a very limited basis) at a number of sites in the U.S. after the phase 3 trial has completed enrollment, which should be very soon. For someone with multi-drug resistant virus the combination of boosted T20 and tipranavir might work well together.

Another protease inhibitor that is effective for resistant virus is TMC-114. This medication is entering phase 3 trials and has shown potential in the preliminary studies. TMC-125 is a non-nucleoside that works against virus resistant to the currently available non-nukes (Sustiva, Viramune, Rescriptor) and hopefully will be entering more advanced studies soon.

There are other entry inhibitors and integrase inhibitors in the pipeline and hopefully we will have more study results to report after the International AIDS Society meeting in Paris next week



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