HIV/AIDS Treatment and Care : Clinical protocols for the European ...

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HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION
Annex 8. Beyond the horizon
Research on ART continues. New viral mutations and drug resistance occur regularly – as do new understandings
of the interactions between drugs and the virus. The following are some of the latest ARVs to be
approved or to be pending approval, along with new combinations of older drugs.
• A once-daily fixed-dose combination of TDF + FTC + EFV has been recently developed and appears to
be slightly more effective than the standard ZDV + 3TC + EFV combination (42).
• TMC125 (etravirine) is a new NNRTI that has potencies despite existing mutations which encode for
NNRTI class resistance (149).
• DRV (darunavir) is a new PI with an even higher genetic barrier than LPV/r. Development of resistance
is slower than with NFV, APV or LPV/r in vitro. TMC114 is available through an expanded access programme
(EAP) (150). It has been recently approved by the US Federal Drug Administration (FDA).
• AG1549 (capravirin) is also a second-generation NNRTI, which is effective despite classical NNRTI
mutations.
• New coreceptor inhibitors in the fusions molecule are coming. CXCR4- and CCR5-expressing viruses
are being fought with drugs that can inhibit one or both of them. New tests for the coreceptor expression
of the virus are needed for this treatment. Side-effects are limited for now, though initial experience with
this new class has revealed cardiotoxic effects. On August 6, 2007, FDA granted accelerated approval to
Selzentry (maraviroc) for combination antiretroviral treatment of adults infected with only CCR5-tropic
HIV-1 detectable, who have evidence of viral Replication and have HIV-1 strains resistant to multiple
antiretroviral agents.