In late November, the U.S. Food and Drug Administration (FDA) approved the first CCR5 antagonist, maraviroc (Selzentry), for treatment-naive individuals with exclusively CCR5-tropic virus (determined using the Trofile assay). Given the first-line approval of the first integrase inhibitor, raltegravir, this past July, people starting ART now have a wider array of effective and well-tolerated options.
The MERIT trial initially suggested that maraviroc did not work quite as well as efavirenz (Sustiva) for treatment-naive people with high viral load, but an analysis using the current, more sensitive Trofile assay found that the two drugs worked equally well after excluding participants originally misclassified as having only CCR5-tropic virus. Maraviroc is well-tolerated overall, and recent studies suggest that it may produce larger CD4 cell gains and reduce inflammation more than drugs from other classes (see "Inflammation, Immune Activation, and HIV").
Liz Highleyman (email@example.com) is a freelance medical writer based in San Francisco.