Hopes rise for patients with drug resistant HIV

BMJ 2002; 325 doi: (Published 13 July 2002) Cite this as: BMJ 2002;325:62
  1. Alex Vass
  1. BMJ

    New treatments may soon be available for patients with HIV which has become resistant to existing treatments.

    The results are from completed phase III trials of a new category of anti-HIV drug called “fusion inhibitors.” The results show that twice as many patients using the first fusion inhibitor, T-20, in combination with antiretroviral drugs, achieved reductions in their viral load to below detectable levels, compared with patients taking antiretroviral drugs alone.

    Significant improvements in immune cell (CD4) counts were also seen in patients taking the fusion inhibitor.

    The results came on the first day of the 14th international AIDS conference in Barcelona.

    Dr Jacob Lalezari, a principal investigator, called them “the most exciting advance since protease inhibitors were introduced.” The addition of T-20 to conventional treatment had, he said, “brought people who had become resistant to current drugs back from the edge.”

    The average patient in the trial had received 12 previous antiretrovirals over the last eight years.

    Fusion inhibitors are one of three distinct classes of anti-HIV compounds, collectively known as entry inhibitors, being investigated. They work to block HIV before it enters the cell, whereas currently available drugs work by preventing replication of HIV after it has infected a cell.

    New categories of anti-HIV drugs are needed to combat the growing problem of antiretroviral resistance. In 1997 just 3.3% of patients were resistant to all classes of antiretroviral. In 2000 a study in the United States showed that over a quarter of patients were resistant to all three classes ofantiretroviral drug.

    Dr Anton Pozniak, a consultant at the Chelsea and Westminster Hospital, speaking at the disclosure of the results, said that levels of drug resistance are likely to reach 42% by 2005.

    “While we wait for a therapeutic vaccine, drugs that will work against resistant viruses have to be developed,” he said.

    T-20, given twice daily by subcutaneous injection, is expected to be licensed later this year and to become commercially available early next year, said Dr Dani Bolognesi, chief executive of Trimeris. The price of the drug, he said, “had not been discussed.”

    The trial results came the day after Dr Peter Piot, executive director of UNAIDS, told thousands of conference delegates that the AIDS battle must be fought on the global political stage.

    “The answers are political. They are about power and priorities,” he said.