AEGiS-Glasgow [KL2] Where are we with ART in 2006?

Eighth International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 12-16 November 2006

[KL2] Where are we with ART in 2006?

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. KL2

Roy M Gulick
Weill Medical College of Cornell University, NY, USA

PURPOSE OF THE STUDY: Currently there are 22 antiretroviral drugs approved for the treatment of HIV infection in 3 mechanistic classes:

HIV reverse transcriptase inhibitors (RTI), including 7 nucleosides, a nucleotide, and 3 non-nucleosides;
10 HIV protease inhibitors (PI); and
an HIV entry inhibitor (EI).

Adding to them the 3 investigational antiretroviral agents available (or anticipated) in expanded access programs raises the total to 25 antiretroviral agents available for HIV therapy. Newer co-formulations reduce potent 3-drug combination therapy to as little as one pill, once a day. Worldwide, an estimated 1.6 million HIV-infected people are currently receiving antiretroviral therapy (ART), representing an estimated 25% of individuals in need of treatment. Despite substantial progress in both research and care, a number of questions remain about ART:

When to start? While cohort studies suggest that starting ART may be delayed safely, newer data suggest the possible benefits of starting treatment earlier as well as the hazards of stopping treatment once it is started.
What to start? Among a number of efficacious ART regimens, recent head-to-head comparative studies help inform the choice for the optimal initial therapy regimen.
What to change to? The successful strategy of designing a regimen including a PI with activity against PI-resistant viral strains together with a compound with a newer mechanism of action (e.g. entry inhibitor, integrase inhibitor) in heavily treatment-experienced patients prompts a new goal for ART in HIV-infected individuals regardless of the stage of HIV infection: durable suppression of HIV RNA levels to <50 copies/ml.

Other areas of active investigation offer promise in relation to newer diagnostic tests, newer treatment strategies and a number of investigational antiretroviral agents, including HIV integrase inhibitors and HIV maturation/gag processing inhibitors. Acknowledging our substantial progress with ART to date, additional gains may be anticipated.

Plenary Session: Keynote Lectures (Past, Present and Future)

2006-11-12
KL2

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