Happy birthday, HAART
It’s now ten years since doctors in the States reported dramatic improvements
in the health of people living with Aids. These people were being treated
with a new class of antiretroviral drug, protease inhibitors. Combined with
a couple of drugs from the nucleoside analogue family, they suppressed HIV
to undetectable levels and raised CD4 cell counts to levels previously thought
impossible.
By the time of the 1996 Vancouver International Aids Conference, this ripple
of optimism had become a wave of excitement as trial data confirmed viral
suppression was possible. Some even spoke tentatively and, with hindsight,
prematurely of a cure. The triple combination therapy cocktail remains the
most historic landmark in the history of the treatment of HIV and Aids.
Looking back, it’s hard to comprehend the phenomenal impact highly active
antiretroviral therapy (HAART) was to have on people’s lives, at least
in the developed world. For many, simply the ability to look back is a miracle
in itself.
We now have over 25 licensed antiretrovirals in the UK and many more in the
pipeline. Choice has never been greater and drug switching is becoming
commonplace. For most people, daily handfuls of pills and bizarre food and
drink restrictions are but a distant memory.
HAART in 2006 is more effective and easier-to-take as well as less toxic than
a decade ago. But it’s still for life, and some find the prospect of
daily pill-popping and side-effects simply too demoralising or depressing
and decline treatments. Some of these people are still with us while others
never made it through to see the drugs become available on a wider scale.
Drug companies get a lot of flak, especially for robustly defending drug patents
in poor countries. They are also berated for their obsession with the quest
of single blockbuster drugs rather than collaborating with others to see how
well their drugs could work alongside their rivals’.
How refreshing then to be able to report that two pharmaceutical giants, Gilead
Sciences and Bristol-Myers Squibb (BMS), have finally found enough common
ground to develop a single dose, once-daily tablet.
The single pill contains two Gilead drugs; tenofovir and FTC, and BMS’s
efavirenz. Progress on the co-formulation is such that the companies are confident
they can show it is as potent, safe and effective as when the component drugs
are taken separately. They will now file for a US licence for the drug. If
successful, we could see European licensing follow swiftly. Obviously, licensing
in Europe will by no means be the end of the story. Clinics will still have
to negotiate hard to enable their patients to access these simplified options.
But anyone who remembers the three-times daily, fasted or fed routines of
the HIV therapies of days past will realise the significance of this current
advance.It shows what can be achieved if there is a will to improve the quality
life of people with HIV. Hopefully this collaboration will also set the tone
for future drug development in decades to come.
Amanda Elliot, managing editor
