milestones in the era of effective hiv treatment · milestones in the era of effective hiv...
TRANSCRIPT
MILESTONES IN THE ERA OF EFFECTIVE HIV TREATMENTThe fi rst HIV med, Retrovir (zidovudine, or AZT), was approved in 1987. Over the next few years, additional antiretrovirals (ARVs) were introduced in the same drug class (nucleoside reverse transcriptase inhibitors, also known as NRTIs, or nukes). But using only one or two meds from the same drug class wasn’t enough to fully suppress the virus, and the crisis period of the epidemic raged on. In December 1995, the fi rst protease inhibitor (PI), Invirase (saquinavir), was approved, and a new era of combination therapy was set to begin. Here’s a timeline of the highlights:
At the 11th International AIDS Conference in Vancouver, numerous studies demonstrate the effi cacy of triple-combination antiretroviral (ARV) treatment, ushering in the era of what was then called highly active antiretroviral treatment, or HAART.
The fi rst viral load test is approved.
The fi rst non-nucleoside
reverse transcriptase
inhibitor (NNRTI, or non-nuke),
Viramune (nevirapine), is
approved.
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The fi rst combination ARV tablet, Combivir (zidovudine/lamivudine), is approved.
AIDS-related deaths drop 47 percent in one year.
The Global Fund to Fight AIDS, Tuberculosis and Malaria in developing nations is launched.
President George W. Bush
launches the U.S. President’s
Emergency Plan for AIDS Relief,
or PEPFAR, pledging to
spend $15 billion to combat the
disease in poorer nations in fi ve years.
The fi rst once-daily, single-tablet ARV
regimen, Atripla (efavirenz/TDF/
emtricitabine), is approved.
The SMART trial is stopped early. The expansive global study investigated whether interrupting HIV treatment
could reduce the risk of diseases thought to be the
result of ARV toxicities. But those who interrupted
treatment actually had worse health outcomes.
The surprise fi ndings spur research into the
link between HIV, chronic infl ammation and non-AIDS-
defi ning conditions such as heart
disease.
The fi rst integrase inhibitor, Isentress (raltegravir), is approved.
The fi rst oral entry inhibitor, Selzentry (maraviroc), is approved.
As HIV treatments improve, U.S. treatment guidelines up the CD4 threshold for starting ARVs to 350.
As San Francisco recommends HIV treatment regardless of CD4 count, U.S. guidelines advise starting ARVs when CD4s drop to 500, while the threshold set by the World Health Organization (WHO) is 350 CD4s.
The HPTN 052 study fi nds that starting
ARVs reduces the risk of transmitting HIV
through heterosexual sex by 96 percent,
launching the treat-ment-as-prevention
(TasP) era.
U.S. guidelines recommend treatment for all people living with HIV, regardless of their CD4 count.
The FDA approves
Truvada (TDF/emtricitabine)
for use as pre-exposure
prophylaxis(PrEP).
UNAIDS reports that global AIDS-related deaths have fallen 30 percent since peaking in 2005.
WHO recommends
treatment once CD4s hit 500 or below.
Interim results from the ongoing
PARTNER study fi nd that there have been
no transmissions between partners
in gay or straight mixed-HIV-status
couples in which the HIV-positive
partner has an undetectable
viral load. Researchers
estimate that the actual
transmission risk may
be close to zero, or in fact zero.
The placebo arm of the global START trial is terminated early when it becomes clear that there is a lower risk of various negative health outcomes associated with starting ARVs when CD4s are above 500 compared with waiting until they hit 350. In response, WHO supports treatment for all, regardless of CD4 count.
Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, or TAF) is the fi rst approved combination tablet to include an updated version of tenofovir that is safer for bones and kidneys.
ment-as-prevention (TasP) era.
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The U.S. Department of Health and Human Services issues the fi rst federal HIV treatment guidelines, recommending treatment for those with fewer than 500 CD4s, in keeping with the “hit early, hit hard” philosophy of the time.
Viread (tenofovir disoproxil
fumarate, or TDF), which comes
with bone and kidney toxicities, is approved and
goes on to become the most widely prescribed ARV.
ALL IMAGES: ISTOCK (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY)
In an about-face, U.S. treatment
guidelines switch to recommending
starting ARVs when CD4s have dropped
to 200 or below.
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The fi rst entry inhibitor, the injectable Fuzeon (enfuvirtide), is approved.
Norvir (ritonavir),
a PI that would become
a booster of other ARVs, is
approved.
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TREATMENT LOWERS THE AMOUNT OF HIV IN YOUR BODY.AND HELPS LOWER THE CHANCE OF PASSING HIV ON.
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