PAGE 22
May 12, 2001
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reason for hope
On the horizon
by David Scondras
Special to Q-Notes
[ This is the second installment of a three-part
seriesl\
Soon we will have better versions of the
drugs we are currently using to fight HIV. These
drugs will fight resistant virus, have fewer side
effects, and be easier to take.
One a day
One new protease inhibitor being made by
Bristol Myers Squibb (BMS) looks like it can
be used once a day. For now, it is called
BMS232632. It appears to be at least twice as
strong as any other protease inhibitor and
seems able to get viral load down in people
whose virus is resistant to three protease in
hibitors. It has kept virus at undetectable lev
els in people taking it once a day for 48 weeks
so far! Also, there has been no evidence yet of
any increase in total cholesterol or triglycer
ides. If the studies continue to show these re
sults, this may be a “ kinder, gentler” protease
inhibitor, with less diarrhea and much less li
podystrophy of the type-connected with pro
tease inhibitors. Perhaps this will also mean
less impact on body shape, but this is far from
certain.
There are other once a day cocktails com
ing out. One very interesting study put to
gether a cocktail combining Boehringer
Ingleheim’s Viramune (nevirapine) with
Dupont’s Sustiva (efavirenz) and BMS’s Videx
(DDI), creating a once a day cocktail without
any use of protease inhibitors. (Videx now
comes in a simple small capsule that is much
easier to take than the giant alka-seltzer size
pill from the old days.) The 26 people in this
study did very, very well (90 percent had very
low viral loads after one year). The findings
are still preliminary, so this therapy is not rec
ommended until other studies can confirm
them — but it is one to watch for.
A new kind of nucleotide, Gilead’s
Tenofovir, will also be a once a day drug when
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it is approved by the FDA. Tenofovir fights
virus resistant to nukes (drugs like AZT, DDI,
3TC and ABC) even though it is similar. We
have hopes it will be the next drug available,
but people who need this new chance at get
ting their virus down now should have their
doctors call l-8pO-GILEAD-5 (the number
is 33-1-44-90-34-46 for those in Europe). This
number will put callers in contact with the
company’s compassionate use program. Eligi
bility for the program is limited, but this might
be an important option for some.
Protease advances
Dupont is developing two second genera
tion protease inhibitors (DPC 681 and DPC
684) that could work on virus that is highly
resistant to all of the other FDA-approved pro
tease inhibitors. They tried these new Pis against
virus that was resistant to four or more current
protease inhibitors and the new drugs look good
against all of them.
A Washington scientist has discovered a spe
cial protease inhibitor. No matter what HIV
does, this protease inhibitor usually sticks to
the virus and stops it. The drug is being tested
by Tibotec, a drug company in Belgium.
NNRTI shows promise
A real problem with NNRTI drugs, like
Sustiva and Viramune, is that they are very
cross resistant. This means if your virus gets
resistant to one, it is probably resistant to both.
Well, good news is finally coming down the
pike. Tibotec is making a similar drug tempo
rarily called TMC120 that seems to work
when the other two fail. Stay tuned for results
of tests in people to see if this is as effective as
predicted.
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Entry inhibitors
Entry inhibitors stop HIV from getting into
cells. These new drugs will transform the world
of HIV therapy because people who have used
up their options will still respond to them and
their side effects will be different and hopefully
less serious than those of the drugs we already
use. If the studies that are now starting are suc
cessful, Roche will be marketing T-20, the first
of the inhibitors, soon. You should call your
local study centers if this is of interest to you.
(Those eligible are anyone who has already had
resistance develop to at least one medicine in
each of the three drug classes that we use to
make up present day cocktails, and who is ready
to switch to a new combo.)
Still to come
Many more new drugs are in the planning
stages.
Panacos Pharmaceuticals is working on a
new powerful kind of inhibitor, 4 methyl DCK,
that works early in the life cycle of HIV.
Achillon Pharmaceuticals is developing a
new nuke that avoids mitochondrial toxicities.
This means it may be less toxic than drugs we
take now. It also appears to be powerful against
virus that is very nuke resistant. It is called
ACH-126,443.
Triangle Pharmaceuticals is testing DAPD,
a new nuke that works on virus resistant to both
AZT and 3TC.
Also on the horizon is a booster for some of
the current drugs. It appears that mycophenolic
acid makes Tenofovir, ABC and DDI stronger.
Early experimentation is revealing that a cock
tail of DDI, Ribavarin and Interferon Alpha can
fight both HIV & Hepatitis C. If the results hold
up, this would be a very important discovery for
the many people who are co-infected.
New tools
Several companies, including ViroLogic,
have new tests that help doctors decide if a drug
is still effective at holding back the virus. These
tests are called “phenotypic and genotypic re
sistance assays.” Shortly, the Commonwealth
of Massachusetts will be funding these tests
through Medicaid. Medicare already does this,
as do most private insurance companies. These
tests are very good news for people whose regi
mens are failing and need to know which drugs
are not working. T
[David Scondras is the founder ofSearch For
A Cure, a not-for-profit organization providing
education and advocacy for people living with
AIDS. Contact Search For A Cure at 34 Edgerly
Road #1, Boston, MA 02115; call 617-536-
2474; fax 617-266-0051; emailhope@sfac.org;
online www.searchforacure.org. This article was
reviewed by Dr. Alfred De Maria, Assistant Com
missioner of Communicable Disease, Massachu
setts Department of Public Health.]