This has been an exciting time for people with advanced and drug-resistant HIV. Never before have so many new and effective drugs come out so close together. In the last few years alone, four powerful drugs have become available that either overcome drug resistance (darunavir and etravirine) or are from a new drug class entirely (maraviroc and raltegravir). People with extensive experience taking HIV drugs have been able to put together, often for the first time, powerful regimens with two or more fully active agents.
The sweet shop is well-stocked. Us kids could even be forgiven for feeling a little complacent. But before we spend all our pocket money, perhaps we should peek behind the counter and check out the store-room.
The marketplace for HIV drugs has become crowded and competitive. The scientific hurdles for developing new HIV drugs have grown more and more difficult, making it a less attractive proposition for companies. Fewer new companies are getting into HIV and some well established ones are either cutting back or eliminating their drug development plans. In fact, the Swiss pharmaceutical company, Roche, has just announced its intention to suspend all research into HIV. Apparently, none of the antiretrovirals they've been working on represent a significant improvement over the ones we've already got. “Research scientists currently working in HIV will be reassigned to other activities,” said Linda Dyson, a spokesperson from Roche’s United States office in New Jersey, in an email recently. (http://www.nytimes.com)
So, what have got to look forward to? In development, there are a few new versions of the same drugs, which will be helpful but not life-changing. And there are some novel compounds which look promising but right now they're struggling due to study results or in one particular case the company being bought by a company that doesn't want to work in HIV.
Then there are those of us who have already exhausted all six drug classes. There are not a lot of us but enough to suggest a burgeoning problem of people beginning to run out of treatment options, as has happened a couple of times during the epidemic. The key now is to design regimens to maintain immunologic and clinical stability while we wait for more drugs.
All this reinforces the importance of using the current crop of new drugs correctly. Your best chance at getting and staying undetectable is to start a regimen with at least two and hopefully three fully active drugs. If you're able to do this and get your HIV level to undetectable, good adherence is the best way of keeping it there.
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