From the Editor's Desk: In This Month's Issue
Among the areas that are always of general interest at medical and scientific conferences, such as the annual Conference on Retroviruses and Opportunistic Infections, are the presentations on the promising investigational agents in late-stage clinical trials and the latest safety data on those recently introduced into clinical practice. In 2007, HIV medicine is fortunate that a number of promising antiretroviral agents in clinical research continue to progress to late-stage development. Several compounds, which represent new drug classes or second-generation agents from traditional antiretroviral drug classes, could possibly enter into clinical practice within 2 to 3 years. Three of these-the integrase inhibitor MK-0518, the CCR5 coreceptor blocker maraviroc, and the second-generation NNRTI etravirine-are currently in phase 3 trials. The latest updates on these agents are eagerly anticipated.
Although last year saw the demise of the investigational HIV protease inhibitor (PI) brecanavir, which had made it into late-stage clinical trials, 2 other PIs-tipranavir and darunavir-did successfully move through clinical testing and are now available, expanding the treatment options and providing some respite for patients with drug-resistant virus whose prospects of finding a viable antiretroviral regimen had been slim. One of these PIs, darunavir, is the subject of a feature article this month. Like tipranavir, darunavir is unusual in that it was specifically developed for use in patients harboring drug-resistant virus.
Darunavir retains its antiviral activity against multi-PIÐresistant viral strains by having a flexible molecular structure, which allows it to bind to shape changes of mutant virus, and, as such, represents a long-awaited advance in the management of HIV disease. Dr Babafemi Taiwo from Northwestern University and Dr Charles Hicks from Duke University Medical School, Durham, NC, who collaborated on this article, present both an overview of the available data and their thoughts on the clinical role of darunavir. Accompanying their review is a commentary coauthored by Dr Brian Boyle, a regular contributor to The AIDS Reader, and Dr Cal Cohen from Harvard Medical School. While reinforcing the benefit of this new PI as part of an active drug regimen for treatment-experienced patients, Drs Boyle and Cohen also provide some caveats for the use of this important agent.
This month's issue of The AIDS Reader also contains an interesting Case Report by Dr Jeffrey Stroup and colleagues of an HIV-infected person with a recent diagnosis of AIDS who presented with mental status changes and ocular pain. The authors correctly diagnosed cytomegalovirus (CMV) encephalitis despite the absence of white bloods cells in the cerebrospinal fluid and no evidence of CMV retinitis on ophthalmological examination.
Along with these 2 feature articles, be sure to check out the regular columns, "Policy Watch" by Dr Kristine Gebbie and "Managing Managed Care" by Dr William Valenti, and the latest photographic case in our "Images in HIV/AIDS" column.
Last, I want to point out that beside the drug profile on darunavir, some of the latest data on tipranavir, the other new PI directed at resistant virus, is summarized in this month's "Research Focus," again by Dr Boyle along with several other experts involved in clinical drug research. These authors present the latest findings on the boosted PIs in current use as well as the ongoing clinical research on other widely used agents, including the NNRTI efavirenz and the 3 available NRTI backbone coformulations. As underscored by the information provided in his column, the pace of antiretroviral drug research and development is now brisk and data from the Retrovirus Conference this year should, as Dr Boyle notes, "bring further information and surprises-some pleasant and some not." We will let you know in our next issue. Take care and be well.
John Hawes, Editor