ÁíôéñåôñïúêÜ ÖÜñìáêá õðü äïêéìÞ

Éïýëéïò 2014

Ùò ôï 2024, ç áíôéñåôñïúêÞ èåñáðåßá (ART) ìðïñåß íá åßíáé ôüóï äéáöïñåôéêÞ áðü åêåßíç ðïõ ÷ñçóéìïðïéåßôáé óÞìåñá ùò ôñéðëÞ èåñáðåßá, üóï Þôáí ôï 1997 üôáí ôï ÁÆÔ Þôáí ôï ìüíï öÜñìáêï ôï 1987, Þ üðùò äñáìáôéêÜ åîåëß÷èçêáí ôá ó÷Þìáôá ôïõ åíüò ÷áðéïý ìßá öïñÜ ôçí çìÝñá ôï 2014 óå óýãêñéóç ìå ôéò ðïëëáðëÝò äüóåéò ôùí êïêôÝçë ôïõ 1997. ÐïëëÜ ìðïñïýí íá ãßíïõí óå 10 ÷ñüíéá, áí êáé ïé íÝåò åîåëßîåéò åí ôÝëåé åîáñôþíôáé áðü öéëüäïîïõò óôü÷ïõò êáé åðáñêåßò ðüñïõò þóôå íá ìðïñÝóïõí íá êáñðïöïñÞóïõí.

ÌáôéÝò óôï ìÝëëïí ôçò ART ðñïóöÝñïõí ôá áíôéñåôñïúêÜ (ARV) ðïõ âñßóêïíôáé öÝôïò õðü äïêéìÞ, üðùò ç Üöéîç ôïõ óõíäõáóôéêïý ÷áðéïý ìå ôï íÝï áíáóôïëÝá éíôåãêñÜóçò dolutegravir êáé ôï íÝï NNRTI rilpivirine, ç äõíáôüôçôá ëÞøçò äýï öáñìÜêùí ìáêñÜò äñÜóçò ðïõ èá öÝñåé åðáíÜóôáóç óôç äïóïëïãßá ôçò èåñáðåßáò êáé ìéá Þðéá åêäï÷Þ ôïõ tenofovir.

Compound

Class/Type

Comments

elvitegravir

INSTI

In November 2013, European Commission approved elvitegravir for use in combination with ritonavir-boosted PIs for individuals without evidence of resistance to elvitegravir

darunavir plus cobicistat
(co-formulation)

PI plus PK booster

EMA application filed October 2013; NDA filed April 2014

atazanavir plus cobicistat
(co-formulation)

PI plus PK booster

NDA filed April 2014

darunavir plus abacavir plus 3TC (co-formulation)

INSTI plus two NRTIs

U.S. and E.U. applications filed in October 2013

tenofovir alafenamide (TAF, GS-7340)

NtRTI (tenofovir prodrug)

In development as FDC component with elvitegravir, cobicistat, and FTC for treatment-naive and –experienced patients. Also as a component of FDC with darunavir, cobicistat, and emtricitabine. FDC with emtricitabine, as follow-up to Truvada, also in development

raltegravir (once-daily formulation)

INSTI

PK data from phase I once-daily formulation (2 x 600 mg tablets) studies presented at EACS 2013 and CROI 2014. A phase III study is expected to begin in 2014

dolutegravir plus
rilpivirine(co-formulation)

INSTI plus NNRTI

Clinical trials evaluating the safety and efficacy of the FDC as two-drug maintenance therapy are expected to begin in early 2015.

darunavir plus cobicistat plus FTC plus TAF
(co-formulation)

PI plus PK booster plus NtRTI and NRTI

Phase II study has been completed. A phase III study of the FDC has not yet been announced

apricitabine

NRTI

3TC-like molecule, stalled at phase IIb with no new studies listed since a phase III study was halted in 2009. A potential role for multiclass-resistant HIV. Partnership announced in December 2013 with NextPharma

BMS-663068

Attachment inhibitor (gp120)

Phase II data presented at CROI 2014

cenicriviroc
(TBR-652)

CCR5 inhibitor (also active against CCR2)

Phase II study results reported at EACS 2013. Tobira plans to study FDC of cenicriviroc plus 3TC in combination with third drug in phase III program

doravirine
(MK-1439)

NNRTI

Phase II data reported at CROI 2014

PRO 140

CCR5-specific humanized monoclonal antibody

No new data since 2010. Phase III trials, including treatment substitution protocol, are planned by CytoDyn

ibalizumab (TMB-355; formerly TNX-355)

CD4-specific humanized IgG4 monoclonal antibody

No data from treatment studies in several years; potential as long-acting preexposure prophylaxis

S/GSK1265744 oral and long-acting parenteral (LAP) formulations

INSTI (follow-up to dolutegravir)

Preliminary data supporting daily oral dosing as maintenance therapy, paired with oral rilpivirine, presented at CROI 2014. Demonstrates potential for once-monthly dosing with rilpivirine-LA

rilpivirine-LA (long-acting formulation)

NNRTI

Preliminary data supporting daily oral dosing as maintenance therapy, paired with oral S/GSK1265744, presented at CROI 2014. Demonstrates potential for once-monthly dosing with S/GSK1265755 LAP

OBP-601 (formerly BMS-986001)

NRTI

d4T-like molecule in phase II, with no new clinical data reported since 2012. Licensing agreement between Oncolys and BMS has been terminated and the compound returned to Oncolys for continued development

albuvirtide

Long-acting
fusion inhibitor

No new data or studies announced since 2013 Pipeline Report

CMX157

NtRTI (similar to TAF)

No new data or studies announced since 2013 Pipeline Report



Lancet

Ðñüóöáôåò äçìïóéåýóåéò óôï ðåñéïäéêü The Lancet HIV

Optimised second-line regimens in the public health approach

Globally, most people receive antiretroviral therapy (ART) in programmes that follow the WHO-recommended public health approach, using a small number of standard regimens and simplified monitoring.1 A single standard regimen—dolutegravir (an integrase strand transfer inhibitor [INSTI]) with tenofovir disoproxil fumarate and lamivudine (both nucleoside reverse transcriptase inhibitors, [NRTIs])—is currently taken by the large majority of people on ART in these programmes, including those on second-line therapy (following previous failure of a non-NRTI regimen).

Prioritising HIV drug resistance testing according to risk

Tenofovir–lamivudine–dolutegravir (TLD) is recommended as an initial treatment regimen and a preferred optimised regimen for people living with HIV without a history of previous viral non-suppression, referred to as TLD in first-line therapy (TLD-1). For people living with HIV with persistent viral non-suppression, TLD largely replaced protease inhibitor-based regimens following efavirenz-based initial regimens, referred to as TLD in second-line therapy (TLD-2), as it is at least as effective, better tolerated, and more affordable.

Ending paediatric AIDS: time to close implementation gaps

WHO's global health sector strategies on HIV, conceived to guide the health sector in implementing strategically focused responses to achieve the goals of ending AIDS by 2030, target a reduction in the number of children aged 0–14 years newly infected with HIV from 150 000 in 2022 to 20 000 in 2025 and 15 000 in 2030.1 To track progress toward these targets, accurate estimations of the number of annual infections in children in each country is crucial. However, in many low-income and middle-income countries, where the burden of paediatric HIV is the highest, children are not systematically tested for HIV in programmes for the prevention of vertical transmission (PVT).

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