Title: The Role of Maraviroc in Antiretroviral Therapy for Treatment-Experienced Patients
1The Role of Maraviroc in Antiretroviral Therapy
for Treatment-Experienced Patients
- Daniel R. Kuritzkes, MD
- Section of Retroviral Therapeutics
- Brigham and Womens Hospital
- Harvard Medical School
2Risk of Virologic Failure and HIV-1 Drug
Resistance after starting ART
Phillips et al AIDS 2005 19487-94
3Prevalence of antiretroviral drug resistance in
US patients in care (1998)
Richman et al AIDS 2004 181393-1401
4Prevalence of multidrug-resistant HIV
- 270,000 patients receiving ART in US1
- 10-15 of treated patients are viremic and have
triple-class drug resistance2 - At least 25,000-40,000 patients could benefit
from better options for treating drug-resistant
HIV-13
1Teshale E, et al. 12th CROI, Boston, 2005
(Abstract 167). 2Napravnik S, et al. Antivir
Ther. 200611S88. Abstract 78. 3Chase M. Wall
Street Journal, February, 2007.
5Changing goals of therapy in highly
antiretroviral-experienced patients
- Goals of therapy20031
- Preserve immune function
- Maximize reduction in plasma HIV-1 RNA
- Minimize toxicity
- Goals of therapy20062,3
- Full viral suppression is an achievable goal
- Newer drugs
- Drugs in new classes
- Use multiple active drugs to achieve full
suppression - Minimize toxicity
1Kuritzkes D. JAIDS 2003 34 (suppl
2)103-10. 2DHHS Guidelines, www.aidsinfo.nih.gov,
October 10, 2006. 3Hammer S et al JAMA.
2006296827-843.
6Why are CCR5 antagonists needed?
- Many highly treatment-experienced patients have
extensive resistance to drugs in existing classes - No single new drug is likely to have durable
activity without additional active agents - Use of several new/active drugs necessary to
achieve and maintain full suppression
7Changing goals of antiretroviral therapy in
treatment-experienced patients
Percent achieving gt1-log reduction in plasma
HIV-1 RNA level (wk 24)
Percent with plasma HIV-1 RNA lt50 copies/mL (wk
24)
Percent achieving endpoint
Source Nelson et al JAIDS 200540404-12 Hicks
et al Lancet 2006368466-75 Lazzarin et al
XVIth Intl AIDS Conf, Toronto, 2006, abstr
ThAB0104 Nelson et al, 14th CROI, Los Angeles,
2007, abstr 104aLB Lalezari et al, 14th CROI,
Los Angeles, 2007, abstr 104bLB
8Potential benefits of maraviroc
- Potent inhibitor of R5 HIV-1 in highly
treatment-experienced patients when combined with
OBR - Safe and well-tolerated in studies to date
- No demonstrated adverse consequences of
administration to patients with D/M or X4 virus
9How should maraviroc be used?
- Maraviroc should be used in combination with
other active drugs in antiretroviral
treatment-experienced patients with R5 virus