An ongoing dialogue on HIV/AIDS, infectious diseases,
April 14th, 2010
Maraviroc Rarely Used for Treatment-Naive Patients
Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks’ Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz — provided that the enhanced-sensitivity tropism test is used to select appropriate candidates.
(The MERIT study began in 2004-5. Don’t think I’ll ever forget that, since the investigator meeting overlapped with this memorable series. Notable event pictured.)
Despite these favorable results from the trial — and the FDA approval of the drug for treatment-naive patients — I agree with Chuck that mariviroc will get little use in this population, if only because the “preferred” alternatives (efavirenz, atazanavir/r, darunavir/r, raltegravir) are so incredibly good.
Our reader poll (right side of page) confirms how rarely the drug is prescribed as initial therapy. I suspect that some of the respondents who said they have given the drug to these patients did so within a clinical trial, which would make the response even lower.
Will maraviroc — or another CCR5 antagonist — ever have widespread use in HIV treatment?
Call me an optimist, but I envision that these drugs will be part of an aggressive eradication strategy, somehow based on the remarkable case of “cure” following bone marrow transplantation from a CCR5-negative donor.
Hey, I can dream can’t I? Red Sox fans certainly did in 2004.
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
Learn more about HIV and ID Observations.
FROM NEJM — Recent Infectious Disease Articles- Andes Hantavirus Outbreak on a Cruise Ship, 2026 June 25, 2026On May 2, hantavirus infection was diagnosed in a patient who had been on a cruise ship. Subsequent evaluation revealed multiple cases of Andes hantavirus infection on the ship. To date, three associated deaths have occurred.
- Phase 3 Results of Bepirovirsen Treatment for Chronic Hepatitis B Virus Infection June 25, 2026In two phase 3 trials, 19% of patients with chronic hepatitis B infection had a functional cure with the antisense oligonucleotide bepirovirsen, 24 weeks after stopping all HBV treatment; functional cure was not seen with placebo.
- Clusters of Concern — Spatial Link between Childhood Undervaccination and Measles Outbreaks in South Carolina June 25, 2026Spatial analysis in South Carolina revealed that measles infections were clustered in areas where public school vaccination rates were lower.
- Improving Global Air-Quality Indices — The WHO’s New Roadmap June 25, 2026Many countries rely on air-quality indices to inform the public and help protect people during short-term increases in air pollution. Their use has important societal and economic implications.
- A Major Step toward a Cure for Hepatitis B Infection June 25, 2026The current treatment of chronic hepatitis B infection includes nucleoside or nucleotide analogue (NA) therapy and pegylated interferon. Both of these treatments are effective in suppressing hepatitis B virus (HBV) replication and in reducing the risk of cirrhosis and hepatocellular carcinoma.1 However, these treatments do not eradicate HBV,...
- Andes Hantavirus Outbreak on a Cruise Ship, 2026 June 25, 2026