Antiviral Strategies

Page 10 of 18
Antiviral Strategies
\ Discussion Paper

The Future of Therapy
The future of antiretroviral therapy is likely to concentrate on the
search for better combinations of new and existing drugs. Most
researchers expect the combination of potent drugs with different mechanisms of action and different resistance patterns will
have the most long-lasting antiviral response. Better drugs, however, doesn't necessarily mean that the drugs will be more potent,
since many of the current combination regimens seem to be about
as potent as therapy can get. Better drugs will be easier to use,
have fewer dietary restrictions, fewer and less severe side effects
and drug interactions, and may require less frequent dosing.
Other antiviral approaches in study include antisense and drugs
that inhibit the integrase enzyme, the tat gene, the rev gene, the
binding of IV to the CD4+ cell, the zinc finger of HIV and
cyclophilin (inhibits fusion of infected and uninfected cells).
Commentary
In addition to overall general health and quality of life factors,
both CD4+ cell counts and viral load must be considered when
making decisions about starting antiretroviral therapy or when
considering switching therapies. In most studies, as would be expected, there is a direct inverse correlation (when one goes down
the other goes up) between viral load and CD4+ cell counts as
r Other PI Publications: -

more virus means more CD4+ cells being infected and destroyed.
There are some individuals, who despite substantial decreases in
HIV RNA levels, continue to experience CD4+ decline. In these
cases it is important for health care providers to conduct more
extensive diagnosis to see if some other condition is affecting CD4+
cell counts, such as common or even not so common infections.
Ideal combination strategies call for the use of fresh new drugs to
be started at the same time. This is readily achievable for people
beginning therapy for the first time but far more difficult for those
who have used many therapies. Existing therapies can sometimes
be juggled to achieve the desired effect. At other times, this may
be impossible. For some people, the best choice may sometimes
be to delay using protease inhibitors or other new therapies until
there are enough new drugs available to initiate an ideal combination (e.g. at least two drug never previously used by the individual). For most people, this will seldom be more than a year
away as several new therapies are on the horizon. But getting
there will require some people to resist the urge to jump to each
new drug as soon as it is available. This shift towards long-term
thinking is the true hallmark of this second decade of anti-HIV
therapy. It must become a part of everyone's thinking. The alternative is the perpetuation of the short-term benefits and longterm failures characteristic of the last decade's approach to therapy.
All of this emphasizes the importance of a recent study which
showed that people who received medical care from physicians
with a great deal of experience treating HIV infection actually lived
longer than those who saw less experienced physicians. The complexity of treating HIV has changed dramatically in the last year
and the demands on the knowledge of physicians have increased
proportionally. Whatever medical strategy a person chooses, it
should begin with finding a physician who is experienced in treating HIV and who is wise enough to continue studying and learning from new developments in HIV research.40

Managing Opportunistic
Infections Discussion Paper
Diagnostics Fact Sheet
Drug Interactions
Fact Sheet
Side Effects Fact Sheet
3TC Fact Sheet
AZT Fact Sheet
d4T Fact Sheet
ddC Fact Sheet

ddl Fact Sheet
Nevirapine Fact Sheet
Protease Inhibitors
Fact Sheet
Indinavir Fact Sheet
Nelfinavir Fact Sheet
Ritonavir Fact Sheet
Saquinavir.Fact Sheet
GW1592 Quick Sheet
141 (vertex) Quick Sheet

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