{"id":5740,"date":"2008-04-23T11:15:14","date_gmt":"2008-04-23T16:15:14","guid":{"rendered":"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/index.php\/2008\/04\/23\/test-copy-of-ps-post-march-3-2008\/"},"modified":"2008-04-23T11:15:14","modified_gmt":"2008-04-23T16:15:14","slug":"test-copy-of-ps-post-march-3-2008","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/test-copy-of-ps-post-march-3-2008\/2008\/04\/23\/","title":{"rendered":"Antiretrovirals in the Pipeline: And Then There Were &#8230; None?"},"content":{"rendered":"<p>The flurry of drug approvals that began in 2005 with tipranavir \u2013 followed rapidly by darunavir, maraviroc, raltegravir, and most recently etravirine \u2013 has been nothing short of astounding. Every experienced HIV clinician now has many patients who are on successful (read: suppressive) treatment for the first time ever. The Vancouver HIV program &#8212;\u00a0wonderfully called \u201cCentre for Excellence\u201d\u00a0(why couldn\u2019t our clinic have chosen that name?) &#8212;\u00a0<a href=\"http:\/\/www.retroconference.org\/2008\/Abstracts\/32952.htm\">reports that the incidence of drug resistance is declining &#8220;drastically.&#8221;<\/a>\u00a0And their experience is not unique, even though their &#8220;excellence&#8221; moniker might be.<\/p>\n<p>All good news, right? Well, mostly. <!--more--><\/p>\n<p>The only downside to all this successful treatment is that the incentive for new drug development must be at an all-time low, especially for antiretrovirals with activity against highly resistant viruses. Unless there\u2019s something flying below the radar, I can&#8217;t think of a single new drug likely to gain FDA approval in the next 2-3 years that will provide an effective option to people with no options \u2013 in other words, for those unlucky few who don&#8217;t have at least two fully active drugs available even with today&#8217;s extensive choices.<\/p>\n<p>But how many patients are in this category? I suspect it&#8217;s not many: a highly unscientific survey identified three &#8212; yes, three &#8212; such individuals among the 1200 or so cared for in our clinics. The pie chart of virologic outcomes for people being treated for HIV now looks like this: undetectable virus (largest piece), detectable virus but patient not taking meds for any number of reasons (2nd largest piece), and finally,\u00a0detectable virus, compliant patient, but no treatment options (just a sliver).<\/p>\n<p>So how many patients with &#8220;no options&#8221; do you care for?\u00a0What do you do for them and tell them?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The flurry of drug approvals that began in 2005 with tipranavir \u2013 followed rapidly by darunavir, maraviroc, raltegravir, and most recently etravirine \u2013 has been nothing short of astounding. Every experienced HIV clinician now has many patients who are on successful (read: suppressive) treatment for the first time ever. The Vancouver HIV program &#8212;\u00a0wonderfully called [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8],"tags":[78,83,290,423,801],"class_list":["post-5740","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","tag-antiretrovirals","tag-art","tag-drug-development","tag-hiv","tag-resistance"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5740","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=5740"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/5740\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=5740"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=5740"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=5740"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}