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please dave we love your no bullshit answers! :-)
Mar 23, 2004

Dr. Dave,

What we love about you are your no bullshit answers. Can you in your style please answer this question, do the new treatments today and those in the pipeline look less toxic, less problematic, and more potent then the meds that were out before like before Viread?

Andy

Response from Dr. Wohl

Dear Andy,

Yes and no (now that IS a bullshit answer). What I mean is that there are these competing needs to develop therapies that are well tolerated but also increasingly potent, especially against resistant virus.

So, we do see kinder and gentler new entries such as tenofovir (Viread) and atazanavir (Reyataz) that are better tolerated and have similar efficacy to previously released drugs in their respective classes. Also, drug makes know now that if they are developing a new NRTI they have to look and see what it does to mitochondria before they enter large scale human studies. So the bar is raised as is consciousness about toxicity.

That said, we all might be accepting of a touch of toxicity from a non-nucleoside that works against virus resistant to the current crop of drugs in this class. Ditto for potent protease inhibitors - most of whom, including new agents in development need ritonavir boosting which adds toxicity. Interestingly, thus far some of the exciting oral entry inhibitors in development seem to be well tolerated.

I think there will be better drugs, however, we need many of these so they can be combined since, your regimen is only as well tolerated as its most toxic drug. Thanks

DW



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