Recent results from studies of some of newer antiretrovirals were presented by Roy Gulick (Professor of Medicine at Weill Medical College, Cornell University, USA). Here’s a brief summary.

• Out of the new protease inhibitors
  • Tipranavir doesn’t quite match up to lopinavir as a first line treatment
  • Darunavir is equally as effective as lopinavir as a first-line treatment
• With the NNRTIs or non-nucleosides
  • Etravirine is effective for people who have developed resistance from being on efavirenz or nevirapine.
  • It is particularly important to watch out for drug interactions with etravirine.
  • Rilpivirine (an equivalent of etravirine) is in phase 3 trials.
• CCR5/entry inhibitors/antagonists
  • As a first line treatment they don’t work as well as efavirenz (when given with AZT and 3TC).
  • Maraviroc works well for treatment experienced people.
  • Vicriviroc is in phase 3 trials.
• Integrase inhibitors
  • Raltegravir looks to be as good as efavirenz as a first-line treatment so long as the other drugs in the combination are effective and you don’t start with a high viral load.
  • Elvitegravir is in phase 3 trials. It looks like it may be a safe option for treatment-experienced people to take a combination containing all three new agents: darunavir, etravirine and raltegravir.
• Starting treatments
  • Professor Gulick summarised findings on the best antiretroviral treatments to start with.
    • The preferred nucleos(t)ide backbone
      • Tenofovir/emtricitabine (Truvada) proved to be superior to abacavir/ lamivudine (Kivexa) for people with viral loads greater than 100,000.
      • Tenofovir/emtricitabine had fewer grade 3 and 4 side effects than abacavir/ lamivudine.
    • Non-Nucleosides (NNRTIs)
      • US guidelines give efavirenz first place
      • Australian guidelines afford equal place to efavirenz and nevirapine
    • Protease inhibitors
      • Lopinavir/ritonavir has immunological and resistance benefits compared to efavirenz but efavirenz has less virological failure.