The next big drug hatches hitches

For nearly five years now, HIVers and activists have eagerly awaited tipranavir (TPV), the Boehringer-Ingelheim (BI) protease inhibitor (PI). With its reputedly high barrier against protease mutations, TPV had held promise for multidrug-resistant (MDR) HIVers and is expected to get FDA approval by mid-2005. But March brought grim tidings for anyone hoping TPV would soup up a pooped-out regimen. When researchers added it to various PI combos in HIVers with heavy PI resistance, TPV undermined the other PIs’ blood levels, perhaps explaining why the strategy vanquished viral load for only about a month. Houston MDR HIVer and treatment activist Nelson Vergel calls the finding “not very promising”—at least in terms of punching up old PIs.

But can TPV triumph if paired with another brand-new drug, such as Fuzeon (T-20)? That’s how some folks took it in the BI study, but inquiring minds won’t know until late fall when the company releases that data. BI virologist Scott McCallister, MD, dares to call those data “encouraging,” adding, “you should continue to be optimistic that [TPV] will find a useful place for treatment-experienced patients.” Let’s hope. Yet it likely needs boosting with twice the amount of ritonavir (Norvir) found in a daily dose of Kaletra (lopinavir plus ritonavir)—which would make for a daily Norvir tab of nearly $35 now that its maker, Abbott, has notoriously raised its price by 400 percent. So will anyone but the most desperate be able to take tipranavir?