The year yielded few HIV headlines (besides “supervirus” hysteria). But
a handful of developments—some with little media fanfare—are paving the
way to positive well-being in 2006 and beyond.
RESISTANCE The year’s big story has been entry inhibitor (EI)
development. By hitting HIV at a unique spot in its reproductive cycle,
EIs may open a brand-new door for containing HIV—and treating people
with resistant virus. Alas, in September, GlaxoSmithKline’s (GSK) EI,
aplaviroc, hit a wall, with some liver toxicity halting trials in those
new to meds. But aplaviroc tests in “treatment-experienced” people
continue, and four other EIs are moving through the pipeline. And
unlike the first approved EI (injectible Fuzeon), these are pills.
MORE OPTIONS Two new protease inhibitors (PIs) arrived in ’05 to offer
additional hope for people dealing with resistance: Aptivus
(tipranavir), debuted in June, and TMC-114 is in expanded access, with
approval anticipated in ’06. “Aptivus is not for those new to therapy,”
says treatment activist Tim Horn. “It’s for HIV that’s resistant to the
older PIs on the market.” TMC-114 is being tested among the
treatment-experienced and -inexperienced alike. Both PIs must be taken
with at least one other drug to which your HIV isn’t resistant.
NEW CLASS OF DRUG Maturation inhibitors disable HIV at yet another
point in its reproductive cycle—when newly formed HIV matures enough to
infect other cells. PA-457 is the first. The pill (likely a once-a-day)
has only graduated from early trials. But it suppressed HIV well enough
to create a minor stir at conferences this year, and Panacos, the med’s
maker, hopes PA-457 will do well enough in studies planned for ’06 and
’07 to get FDA approval in ’08.
A VACCINE FOR HPV 2005 saw
progress on vaccines for human papillomavirus (HPV), an STD that
plagues and endangers those with HIV. Some strains of HPV cause genital
warts; others cause serious lesions in the cervix and anus that can
lead to cancer. Cervical cancer—an AIDS-defining illness—progresses
faster in positive women than negative ones. In a study (of 25,000-plus
women in 33 countries) announced in October, Merck’s vax for
cancer-causing HPV, Gardasil, blocked 100% of cancerous and
precancerous cervical lesions in those who got all the vax doses. Even
women who got HPV before getting all the doses had a lower risk of
getting the lesions. GSK is testing an HPV vax, too. However, neither
has been tested in positive women. If the vax does work in women with
HIV, it could cut cancer risk, although prospects are iffier for those
with CD4 cells below 200.
FULLER FACES Only one filler
(Sculptra) is approved in the U.S. for HIV’s facial wasting. But
Bio-Alcamid (polyalkylamide gel), for which HIVers have trekked to
Tijuana, can now be had via “special access” in Canada (see
www.purmedical.com). It’s another potential step—although across a
border—to better quality of life for those with HIV.