From a treatment standpoint, the 2007 CROI will be remembered primarily for the BENCHMRK and MOTIVATE trials (see New Data on Treatment-Experienced Patients and Drug Resistance on p 4), which foretell the dawn of a new era in which most HIV- infected patients who are adherent to therapy will be able to achieve virologic suppression despite extensive resistance. The data on initial therapy was less earth-shattering, but still important.
The first integrase inhibitor likely to receive FDA-approval has demonstrated impressive efficacy at 16-weeks in the BENCHMRK studies. Phase II data presented by Markowitz at last year’s International AIDS Conference [Abstract THLB0214] intimate that this drug may even be able to give efavirenz a run for first-line therapy. Maraviroc also has demonstrated impressive early efficacy in experienced patients in the MOTIVATE trials.
Kelly Gebo, M.D. M.P.H. and Lucy Wilson M.D., Sc.M.
Findings presented at the 14th CROI demonstrated that viral hepatitis is an increasing cause of morbidity and mortality, that successful vaccination of HIV infected patients may require additional vaccines beyond the traditional 3 shot series, questioned the accuracy of liver biopsy and suggested that alternative non-invasive measures of liver fibrosis may be beneficial in the management and treatment of hepatitis co-infection in HIV infected patients.
CD4 cell depletion is a fascinating topic that clearly needs further exploration. The results of the studies presented have major implications for the decision of when to initiate HAART. In macaques, the degree of CD4 depletion in primary infection correlates with mortality. If this is also true for HIV infection, then it may make sense to initiate HAART during primary infection to preserve these cells where possible.
New data on antiretroviral therapy were sparse at the 46th ICAAC, held in San Francisco in September. A few of the most important studies are discussed.
Kristine Johnson, M.D., and Emily Erbelding M.D., M.P.H.
The sessions with HIV content at the meetings of IDSA tend to be designed to provide broad and timely updates on HIV for the infectious disease practitioner, as well as to allow a forum for the presentation of research findings. This article will summarize some IDSA highlights relevant to acute
HIV infection, epidemiology and prevention.
In the treatment of chronic hepatitis B, telbivudine offers clinicians a more potent alternative to lamivudine and adefovir. In vitro, it is active against lamivudine-resistant strains with the M204V mutation, but the clinical efficacy against this mutant remains to be
determined. Although, the resistance rate to telbivudine is lower and slower to develop than with lamivudine, the rate is still high. making it difficult to determine the optimal use for this agent. In contrast to adefovir, lamivudine, and emtricitabine, telbivudine does not have activity against
HIV.
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