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Long-term effect of CD4 tropism on ARV therapy Posted: Jun 30, 2007 QUESTION: Can changes in CD4 tropism from CCR5 to CXCR4 affect ARV efficacy or durability of response to treatment with currently available agents? If so, what are the implications for use of maraviroc in early HIV infection, where it is likely to be more effective, and its influence on first line therapies such as efavirenz or atazanavir?


RESPONSE FROM: The currently approved crop of HIV meds work to inhibit R5 and R4 virus, so that seems to be less of a concern than other issues surrounding tropism switch during maraviroc. Foresmost is whether R4 virus is more pathogenic and therefore worse than having R5 virus. Data are mixed here and there are no long term data following maraviroc failure ot help us out here. We will need to learn more about this issue, I feel, prior to feeling completely confident about early use of maraviroc. DW

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