Aptivus needs to be boosted. If you are taking it, you'll also be taking Norvir® (ritonavir) to keep the level of drug up enough to fight the HIV. And of course, like other antiretrovirals, it should only be used in combination therapy. This can be sort of a "Catch 22" for anyone considering Aptivus. We know that adding one drug to a combination when you're resistant to the others already isn't the best way to go. What generally happens is that you will develop resistance to the new drug (in this case, Aptivus) pretty quickly, since it's the equivalent of monotherapy. And of course, you wouldn't consider Aptivus unless you have resistance to a fair number of antiretrovirals.
There are a couple of strategies that can help you get as much mileage as possible when using Aptivus. Resistance testing can help, because it can show what antiretrovirals may be effective as far as keeping HIV suppressed in a particular individual. And clinical trials that combined Aptivus with Fuzeon® (enfuvirtide, T-20) showed better results than other combinations, especially for people who have never taken Fuzeon before. Some people are reluctant to get involved with Fuzeon (it's only available as an injection), but the benefits of the combination certainly make it worth serious consideration, even if you don't like needles. If you're taking a regimen that includes Aptivus and your viral load begins a steady increase, you'll have a very limited range of options. There are other drugs in development now, but they are only available through clinical trials.
GlaxoSmithKline recently issued a press release concerning their CCR5 entry inhibitor, aplaviroc. It's being tested in clinical trials, and there have been enough reports of hepatotoxicity (liver problems) for them to stop the involvement of anyone who is antiretroviral-naive. This may sound great if you're antiretroviral-experienced, since it means more opportunity for you to get into future trials that involve aplaviroc. The not-so-great part is that ... well, aplaviroc can be hard on your liver. If you have hepatitis C or anything else that might cause liver problems, you may not be able to tolerate this drug; at the very least, you will likely be excluded from clinical trials due to safety concerns while GlaxoSmithKline sorts everything out.
There are other CCR5 entry inhibitors in development. The pharmaceutical company Pfizer is developing one called maraviroc which has reached phase III clinical trials, the last stage before FDA approval. Vicriviroc, Schering-Plough's CCR5 inhibitor, is at about the same stage. If there are no problems, we may see them on the market in two to three years. If you want more information on antiretrovirals under development or have a question about treatment education, please call or stop by our Treatment Resource Center.
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