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Exploring Current and Future HIV Treatment Options: Challenges and Innovations

This article delves into the complex landscape of HIV treatment options, including established antiretrovirals like AZT and newer strategies such as fixed-dose combinations. The challenges of drug resistance, side effects, and adherence are highlighted, alongside the need for more accessible monitoring. Future treatment possibilities, including immune therapies and prophylactic drugs, outline the evolving fight against HIV. Insights from regions like Henan Province emphasize the importance of training and direct observation strategies in improving treatment outcomes.

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Exploring Current and Future HIV Treatment Options: Challenges and Innovations

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  1. Treatments, Current & Future Jon Cohen Science Magazine

  2. Deciphering the Alphabet Soup:HIV Treatment Options and Limitations AZT d4T ddI ddC NVP EFV IND SQV 3TC FTC T-20 RT NRTI NNRTI PI FI CD4 CCR5 VL

  3. Covering Key Treatment Issues • Dizzying array of drugs • Drugs target different vulnerable spots • Problems w/drugs: Resistance, side effects • Adherence: Simpler dosing badly needed • Monitoring: too expensive for most • Creative strategies: STIs, prophylaxis

  4. Know the Enemy HIV CCR5 Receptor CD4 Receptor CD4 White Blood cell

  5. HIV’s Life Cycle: Dumbed down version CD4 White Blood Cell HIV HIV HIV HIV HIV HIV HIV HIV

  6. HIV’s Life Cycle: Smart version HIV CD4 cell

  7. HIV’s Life Cycle Up close • Entry • Reverse Transcription • Integration • Transcription • Assembly • Budding

  8. U.S. FDA June 2004

  9. The Cocktails Work Percentage of Patient-days on HAART Deaths per 100 Person-Years Frank Palella/HOPS

  10. WHO Recommended Cocktails in Resource-Limited Settings AZT/3TC* + NVP or EFV** **Alternatives to NVP or EFV: PIs *Alternatives to AZT/3TC: d4T/3TC, ZDV/ddI and ddI/3TC OR 1 pill/2x day 1 pill/2x day 1 pill/2x day 1 pill/day 5 or 6 pills/day =

  11. But a tangled web of serious problems—and important stories—exist Biological Financial Practical Political Technical

  12. Resistance

  13. Side Effects

  14. The Story of Henan Henan Province had 20% dropout first year, and NVP resistance in first 9 months was 20%-30%.

  15. Solution: Direct Observation of Treatment Strategy (DOTS)

  16. Solution: FDC(Fixed Dose Combination)

  17. Solution: Proper training and monitoring

  18. Biological: Resistance and side effects Financial: Lack of monitoring, training, and 2nd line Tx Practical: Pills/day Technical: Do generics = brand name? Political: Export limits per WTO, No generic 3TC in China Lessons from Henan

  19. Future Treatment Possibilities Structured Treatment Interruptions (STI): Little evidence that it works, but might Dybul et al, JID, 2004

  20. Future Treatment Possibilities New Targets

  21. Future Treatment Possibilities Immune Therapies • Therapeutic vaccination • Interleukin-2 • CD4 and CD8 cell infusions

  22. Future Treatment Possibilities Drugs as Prophylaxis: Tenofovir Study

  23. HIV treatment is jumping from river stone to river stone

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