Question
Are there new treatments available for drug resistant HIV?
24 March 2007. Related: All topics, Changing treatment, Resistance.
Are there new treatments available for drug resistant HIV?
What is the chance of survival for people who are infected with drug resistant HIV?
Answer
There is a lot of information about treatment of drug-resistant HIV in the i-Base guide Changing Treatment: second line therapy & drug resistance.
Please let us know if you’d like us to send you a print copy.
This guide was updated in April 2007 so includes information about the next new drugs, many of which are already available in Europe on expanded access programmes.
This includes a new integrase inhibitor called raltegravir (formally MK-0518), and new CCR5 inhibitor (called maraviroc), a new protease inhibitor darunavir (formally, TMC-114 and this month approved in Europe) and a new NNRTI called etravirine (formally TMC-125).
If you have never used a drug from a new class: integrase inhibitors, CCR5 inhibitors, or, for many people, fusion inhibitors, then they will all work against HIV that is resistant to drugs from the first three classes of drugs: nukes, NNRTIs and protease inhibitors.
To answer your second question, the key to chance of survival for people with drug resistance, is that with these new treatment the chance is very very promising. You need to make sure that each of these drugs are only used in combinations that include at least another two drugs that are also definitely active.
This will probably include using them together, or using them with a fusion inhibitor called T-20. This is because all these new drugs are also vulnerable to resistance if other drugs in the combination are not active.
In a study reported at a conference last month, 98% of people using raltegravir, darunavir and T-20 for the first time, (a sub group of a larger raltegravir trial) were able to get there viral load reduced to less than 400 copies/mL after 16 weeks.
I’m not sure which country you live in, but I assumed that your email was from Europe, the US or a Western country with access to these drugs.
If you are writing from a country that has more limited access to treatment, the principles of choosing new drugs are similar but your individual treatment history becomes much more important in deciding which drugs may work from nukes, NNRTIs and protease inhibitors. Information in the guide above still covers this.
Please write with more details if this is the case, and I can reply either online, or confidentially by private email.
Hi Jonno
Prezista is the trade name for darunavir, so they are the same drug.
It is now approved in the UK, so any doctor should be able to prescribe it. The previous compassionate access programme may still be running if there is any administrative hold up in regular access, but as the price is already set, then people on this programme will switch now to regular prescriptions.
As with all new drugs, it needs to be used with other drugs that are active against your HIV. For many people this will involve using raltegravir (the new integrase inhibitor) especially with T-20 (enfuvirtide) if they haven’t used this drug before.
Raltegravir is available on expanded access in the UK, as is maraviroc (a CCR5 inhibitor) and etravirine (a new NNRTI).
If you search ‘darunavir’ or ‘TMC-114’ on the i-Base website you’ll find more information.
We also posted a PDF file of an April 2007 Guide to Changing Treatment yesterday, which has more updated information than the February 2007 version that is currently online as web pages.
The i-Base phoneline runs Mon, Tues, Wed from 12-4pm if you’d like to talk to someone in more detail.
Is darunavir Prezista?
When will it be licensed in the UK?
Is it available on compassionate access yet (and if it is where can I get info on this)?
thnx