2 HIV meds enter global health talk

DURHAM, N.C. (U-WIRE) – AIDS researchers at Merck & Co. and Pfizer announced last week the addition of two new weapons in the arsenal of HIV drugs.

The two drugs, Pfizer’s maraviroc and Merck’s raltegravir, will be used in combination with other drugs, a practice called highly active antiretroviral therapy, in which patients take a consistent regimen of multiple drugs, according to The New York Times.

Clinical trials of maraviroc have dramatically reduced levels of the virus in patients after 24 weeks.

The two new drugs aim to help people who have already exhausted existing drugs, called salvage therapy, said Sherryl Broverman, associate professor of the practice of biology.

Dr. Michael Greenberg, former adjunct professor and current vice president of research at Trimeris, Inc., a biopharmaceutical company, said an advisory committee is meeting in April to discuss the approval of Pfizer’s drug, while Merck’s could take longer.

“These drugs will help bring the viral load down so much so that (the patients) won’t transmit the virus,” Greenberg said. “I think you get a flavor of the excitement I have, that I think it is going to make an impact in a big way if these (drugs) can get approved.”

Although the Food and Drug Administration has not yet signed off on the drugs, Dr. James Hoxie, director of the University of Pennsylvania’s Center for AIDS Research, said science has come a long way since the epidemic was first recognized more than 20 years ago.

“We are moving into a new era where there are more weapons,” Hoxie said. “Because the virus mutates so dramatically, it can, in a rather short amount of time, become resistant to any drug we use. What has happened is as more and more of the same kinds of drugs have come out, in time the virus really has caught up with them.”

According to the World Health Organization’s website, infections caused by HIV retroviruses, which lead to AIDS, can be treated with antiretroviral drugs. Different classes of antiretrovirals act at different stages of the HIV life cycle, slowing the replication of the virus.

These new drugs interfere with the viral life cycle in new ways, Hoxie added.

“It tells you the climate in science is tremendously exciting,” he said. “It is an example for graduate students and undergraduates at Duke and Penn and everywhere that AIDS is one disease that when good questions were asked and research was conducted well, that there is real potential to get a therapeutic handle on HIV, and that is exciting to everybody.” Broverman, who teaches a biology class on AIDS and other emerging diseases, said the drugs may help patients at Duke’s AIDS Research and Treatment Center manage their viral loads. There is always the question, however, of how these crucial medicines will be distributed to people in developing countries, she said.

“It is great to have new drugs out there for those who can afford them,” said Broverman, who spent last summer doing research in Kenya. “Anyone who has access to top-of-the-line drugs is going to benefit from them. The question is: Who gets top-of-the-line drugs?”

Sophomore Katie Mikush conducted research at a rural community school in Kenya last summer.

While the drugs are exciting, she said they are only half the battle.

Mikush added that great poverty and the high price of drugs prevent widespread distribution of antiretrovirals.

“There are so many barriers for the poorest people in the world to access the drugs,” Mikush said. “In areas with high HIV rates, it is unrealistic to say that once they come out with a new drug the problem will be solved.”

Following in Mikush’s footsteps is sophomore Jason Pate, who is participating in a program this summer in Kenya sponsored by Coca-Cola to aid antiretroviral distribution in rural cities. He said Coke’s distribution infrastructure will improve access to the drugs.

“As a consequence of the inequalities in access to antiretroviral drugs, there is a growing consensus that no matter where one lives, one has a basic human right to essential medications and vaccines,” Dr. Michael Merson, chair of Duke’s Global Health Institute, wrote in a February column in The Chronicle.

Hoxie said that of the 40 to 50 million people infected worldwide, a vast majority of these people are in countries least prepared to deal with it.

Improving distribution in these developing countries is at the top of Hoxie’s list.

“You need to stress that the epidemic in the United States continues, so it’s not over here by a long shot and that the epidemics in developing countries are devastating, just truly devastating,” he said.