Volume 7 Number 10 October 2006

As this issue went to press, named-patient programmes were about to start for both MK-0518 and TMC-125. Although he number of patients with multi-drug resistant HIV who are failing treatment is the UK is low – the 2006 BHIVA audit suggest that less than 3% of HIV-related deaths in the UK are related to lack of treatment options – for those patients these early access programmes clearly offer life-saving options.

Together with other recently approved or available drugs (T-20, tipranavir, darunavir), patients with multi-drug resistance (MDR) now have the strongest opportunity for many years of achieving and sustaining undetectable viral load. Both the new UK and US treatment guidelines have been updated to recognise this fundamental shift in aiming for maximal viral suppression in patients with MDR.

There is further optimism from new classes of drugs in the pipeline: CCR5 inhibitors, budding inhibitors and a monoclonal antibody that, as drugs in new classes, are expected to work against MDR HIV.

The BHIVA guidelines strongest caution is to always use at least 2 new sensitive drugs in any combination – and these choices mean some people will be able to use three sensitive drugs. A second caution relates to potential interactions. Currently, darunavir has fewer interactions than tipranavir. MK-0518 looks to have fewer interactions still – with a question only over TMC-125. Until the results of an interactions study between MK-0518 and TMC-125 are available, these drugs should not be used together.