Expanded access and experimental drugs
You can sometimes use new drugs before they are licensed by using an Expanded Access Programme (EAP) or Named Patient Programme (NPP).
These programmes allow limited access to a promising drug while approval is being processed.
EAP and NPP access is provided for most new drugs, but it is sometimes very difficult to predict when each programme will start. They are provided for people in the greatest need.
These drugs can be the key to your next combination. You will also be monitored very carefully for side-effects and to check they are working.
These programmes are not always available at all hospitals. You may need to register at another clinic to access them. Your doctor should be able to help you do this. Get to know which drugs are in the pipeline and ask your doctor to give you the choice to use them.
The following compounds are being studied as new treatments:
- NRTIs: CMX157 (similar to tenofovir).
- NNRTIs: rilpivirine, lersivirine, GSK761, RDEA806.
- Integrase inhibitors: elvitegravir, GSK572.
- CCR5 inhibitors: TBR-652.
- Maturation inhibitors: beviramat.
As we went to press, these drugs were not yet available in the UK in EAPs.
Additional new drugs are likely to become available before this booklet is updated.
Other treatments
Several non-HIV drugs may have a role because they have some activity against HIV or for other reasons.
Many of these drugs are approved for other uses and can be prescribed on a named patient basis.
PEG Interferon (Interferon alpha): A once-weekly injectable hepatitis C drug. Anti-HIV activity (and side effects) increases with dose used (as with regular interferon alpha).
Gm-CSF: A drug used to boost your immune system, reduced the risk of new illnesses in people with a CD4 count less than 50 cells/mm3.
foscarnet: CMV drug with anti-HIV activity that may resensitise AZT-resistant virus. Best used for only 2-4 weeks to reduce viral load before starting a new regimen, as probably too toxic for long-term use.
hydroxyurea (HU): A 30-year-old anti-cancer drug that can resensitise HIV to ddI. Now rarely used or only at a reduced dose of 300 mg once-daily.
mycophenolic acid: May boost abacavir levels in a similar way to hydroxyurea and ddI. Limited studies showed a benefit using 500mg twice-daily.
L-acetyl carnitine: An amino acid that has no anti-HIV effect but may minimise or reverse peripheral neuropathy associated with (nuke) drugs.