Tired of taking pills everyday? In the future, you may not have to!
When we started using combination therapy to treat HIV infection in the mid 1990’s, were finally able to totally suppress the virus from replicating. This came at a price where these early drug combinations required the patient to take many pills up to three times a days. It sometimes became difficult for patients to stay controlled when they had to take so many pills multiple times a day. A major achievement was developing combinations that only needed to be taken once a day, and then to combine combinations into a single pill. It doesn’t get any better than that. Or does it?
A number of HIV drugs are being developed that may only have to be taken once a month, or even less! The drug rilpivirine (Edurant) is in the same class as Efavirennz (Sustiva, Atripla) and Etravirine (Intellence). It is dosed once a day and is formulated a combination pill with rilpivirine, tenofovir and emtricitibine (called Complera). But once a day just didn’t seem to be good enough. A preparation of rilpivirine is being developed that would be injected into the muscle once a month! The preparation is developed so that it is slowly released from the tissue to maintain steady-blood levels for an entire month.
The company Glaxo Smith Kline is developing a new integrase inhibitor (GSK744LAP) that is long-acting and can probably be dosed monthly as well. It is important that long-acting drugs from different classes be developed because combination therapy is required. It also defeats the purpose of convenience if one drug in the regimen can be taken once a month and the other drugs in the regimen have to be taken everyday.
In addition to their use in HIV-infected individuals. These long-acting drugs may have use in PreP, to prevent HIV infection. People who are not infected may not be as attentive to taking the medicines daily since they don’t have the infection. These long-acting drugs may be better at prevention.
An investigational drug that “Tag-Teams” the HIV virus
Cenicriviroc is an investigational drug that in showing a lot of promise in clinical studies. This drug is unique in having two effects that can be important in treating HIV infection. First Cenicrivroc works by the same mechanism as the drug Mariviroc (Selzentry), by blocking a key target that HIV uses to infect blood cells. It is in the class of entry inhibitors, since it blocks HIV’s entry and infection of cells. This is clearly the most effective and important action of the drug. But in addition, it can suppress inflammation. This inflammation from HIV infection can actually drive the disease process and may be responsible for complications from HIV infection, such as heart disease (see my articles from the blackdoctor.org archives on HIV and inflammation). It will be interesting to see the effect of this drug (if it gets approved) on reducing the long-term complications of HIV infection, like heart disease and some cancers.
Always remember, HIV medicines only work when they’re taken properly. If the virus becomes resistant to the medicine, it no longer works. Resistance to one drug in your regimen may also effect other drugs in the class even if you are not taking those drugs. Keep as many treatment options available by taking your currently prescribed medicines as directed and notifying your health providers whenever you have problems or questions.
HIV/AIDS: What New Treatment Options Are Available? was originally published on blackdoctor.org
