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Top 10 HIV Clinical Developments of 2012

December 2012

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Hepatitis C (HCV) Therapy: Game On

It is as if some noble hepatologist found a bottle, rubbed it, got some wishes and "poof": Amazingly better cures for HCV appeared. Well, almost. It does not take much to improve upon the archaic, toxic and only modestly effective combination of interferon and ribavirin. The recent approvals of boceprevir and telaprevir are upgrades as far as response rates go, but they also pile on more side effects and complexity.

The genie, though, is on it: This year, we saw a maddening array of HCV drugs in development. It portends a future for HCV therapy that looks a lot like what we have for HIV now -- except we are talking cure here, people.

Pharmaceutical companies you have and have not heard of are conducting studies of potent molecules. Some of these agents play well with others, don't rely on interferon, and have been presented or described in press releases with rates of sustained virologic suppression that can make one giddy. Jeez Louise, some of these may even be able to lose the ribavirin and be coformulated! If even two or three of the drugs in later-stage development come to market, we are in for a revolution in HCV care.

There are less data regarding most of these promising agents in those who are coinfected with HIV, but what we have seen so far looks good. Drug interactions will need to continue to be investigated, certainly, but could the situation be much worse than what we have now?

That we are so tantalizingly close to a major medical breakthrough is exciting for our patients and us. Almost certain to make it to the FDA approval finish line will be sofosbuvir, the tongue-punishing name of an NRTI in the final phases of clinical study, including in HIV coinfection. Daclastasvir, an NS5A inhibitor, also looks potent and promising.

Learning how to best use these new drugs will be our task over the next couple of years, but it was in 2012 that the notion of short-course, well-tolerated, highly active, interferon-free HCV therapy became more than wishful thinking.

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Reader Comments:

Comment by: Ashley (QMsiijnYJx) Thu., Jan. 10, 2013 at 10:18 am EST
the HIV virus is very fragile once it is oudtsie of the human body. when it is exposed to the air, it dies in about 2 hours. so, dried semen will only have dead HIV cells. you are safe.
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Comment by: Mani (UubwaSyASLWZnBAlN) Thu., Jan. 10, 2013 at 9:29 am EST
I've talked to both my patrens about it at differnt times. My mom thinks it nessasary. She knows that teens r going to have sex and they need to be educated.My dad thinks its better to be educated then to not know anythingI think sex-ed is needed for everyone. I never though my dad (the republican who was in the army) Would be so libral
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Comment by: harleymc Tue., Dec. 25, 2012 at 11:02 pm EST
I was very happy to read this article.
I'm someone who's been on combinations containing boosted PIs and suffer badly with them. When my current script runs out in a few days I'll be switching to TDF/FTC/rilpivirine + raltegravir (already on the raltegravir). It was reassurring to read of an improvement in outcomes.

It's one thing to have a fabulous viral load but when side effects are both vile and life threatening, a change sounds brilliant.
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Comment by: Anonymous Mon., Dec. 17, 2012 at 10:48 am EST
good message of hope
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Comment by: Sean (Dublin, Ireland) Fri., Dec. 14, 2012 at 6:38 am EST
Thanks for the section called "The Cure Agenda". If YOU are feeling optimistic, that makes me feel optimistic.

Happy Yule!
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Comment by: Patrick D (South Deerfield, MA) Thu., Dec. 13, 2012 at 3:56 pm EST
Dr. Wohl writes "In the past, I have played with the HIV therapies of patients doing well, and on more than a few occasions I have been burned," then describes some of the benefits that may come from switching from a more complex drug regime to a more simplified one. Dr. Wohl clearly has his patients best interests in mind, but I want to remind him that when a switch in meds fails (temporarily or permanently) for patients who had been doing well on an older regime, it isn't the doctor who gets burned, it's the patient. I have had occasion to remind my own doctors of this, when they seem to want to fiddle with a regime that is working perfectly well, with negligible side effects, for no other reason than to put their signature on my treatment.

It can indeed be a benefit to simplify a drug regime, especially for patients who have trouble taking their meds in the first place. But as I've reminded several doctors, for many HIV patients, HIV drugs are not the only drugs we're taking (and that's not taking supplements into account), so simplifying the HIV drug regime alone doesn't result in not taking other drugs at other times of the day, and thus may not be a strong reason for changing a regime that's working.
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