Ως το 2024, η αντιρετροϊκή θεραπεία (ART) μπορεί να είναι τόσο διαφορετική από εκείνη που χρησιμοποιείται σήμερα ως τριπλή θεραπεία, όσο ήταν το 1997 όταν το ΑΖΤ ήταν το μόνο φάρμακο το 1987, ή όπως δραματικά εξελίχθηκαν τα σχήματα του ενός χαπιού μία φορά την ημέρα το 2014 σε σύγκριση με τις πολλαπλές δόσεις των κοκτέηλ του 1997. Πολλά μπορούν να γίνουν σε 10 χρόνια, αν και οι νέες εξελίξεις εν τέλει εξαρτώνται από φιλόδοξους στόχους και επαρκείς πόρους ώστε να μπορέσουν να καρποφορήσουν.
Ματιές στο μέλλον της ART προσφέρουν τα αντιρετροϊκά (ARV) που βρίσκονται φέτος υπό δοκιμή, όπως η άφιξη του συνδυαστικού χαπιού με το νέο αναστολέα ιντεγκράσης dolutegravir και το νέο NNRTI rilpivirine, η δυνατότητα λήψης δύο φαρμάκων μακράς δράσης που θα φέρει επανάσταση στη δοσολογία της θεραπείας και μια ήπια εκδοχή του tenofovir.
Compound |
Class/Type |
Comments |
elvitegravir |
INSTI |
In November 2013, European Commission approved elvitegravir for use in combination with ritonavir-boosted PIs for individuals without evidence of resistance to elvitegravir |
darunavir plus cobicistat |
PI plus PK booster |
EMA application filed October 2013; NDA filed April 2014 |
atazanavir plus cobicistat |
PI plus PK booster |
NDA filed April 2014 |
darunavir plus abacavir plus 3TC (co-formulation) |
INSTI plus two NRTIs |
U.S. and E.U. applications filed in October 2013 |
tenofovir alafenamide (TAF, GS-7340) |
NtRTI (tenofovir prodrug) |
In development as FDC component with elvitegravir, cobicistat, and FTC for treatment-naive and –experienced patients. Also as a component of FDC with darunavir, cobicistat, and emtricitabine. FDC with emtricitabine, as follow-up to Truvada, also in development |
raltegravir (once-daily formulation) |
INSTI |
PK data from phase I once-daily formulation (2 x 600 mg tablets) studies presented at EACS 2013 and CROI 2014. A phase III study is expected to begin in 2014 |
dolutegravir plus |
INSTI plus NNRTI |
Clinical trials evaluating the safety and efficacy of the FDC as two-drug maintenance therapy are expected to begin in early 2015. |
darunavir plus cobicistat plus FTC plus TAF |
PI plus PK booster plus NtRTI and NRTI |
Phase II study has been completed. A phase III study of the FDC has not yet been announced |
apricitabine |
NRTI |
3TC-like molecule, stalled at phase IIb with no new studies listed since a phase III study was halted in 2009. A potential role for multiclass-resistant HIV. Partnership announced in December 2013 with NextPharma |
BMS-663068 |
Attachment inhibitor (gp120) |
Phase II data presented at CROI 2014 |
cenicriviroc |
CCR5 inhibitor (also active against CCR2) |
Phase II study results reported at EACS 2013. Tobira plans to study FDC of cenicriviroc plus 3TC in combination with third drug in phase III program |
doravirine |
NNRTI |
Phase II data reported at CROI 2014 |
PRO 140 |
CCR5-specific humanized monoclonal antibody |
No new data since 2010. Phase III trials, including treatment substitution protocol, are planned by CytoDyn |
ibalizumab (TMB-355; formerly TNX-355) |
CD4-specific humanized IgG4 monoclonal antibody |
No data from treatment studies in several years; potential as long-acting preexposure prophylaxis |
S/GSK1265744 oral and long-acting parenteral (LAP) formulations |
INSTI (follow-up to dolutegravir) |
Preliminary data supporting daily oral dosing as maintenance therapy, paired with oral rilpivirine, presented at CROI 2014. Demonstrates potential for once-monthly dosing with rilpivirine-LA |
rilpivirine-LA (long-acting formulation) |
NNRTI |
Preliminary data supporting daily oral dosing as maintenance therapy, paired with oral S/GSK1265744, presented at CROI 2014. Demonstrates potential for once-monthly dosing with S/GSK1265755 LAP |
OBP-601 (formerly BMS-986001) |
NRTI |
d4T-like molecule in phase II, with no new clinical data reported since 2012. Licensing agreement between Oncolys and BMS has been terminated and the compound returned to Oncolys for continued development |
albuvirtide |
Long-acting |
No new data or studies announced since 2013 Pipeline Report |
CMX157 |
NtRTI (similar to TAF) |
No new data or studies announced since 2013 Pipeline Report |