Selected Findings from the Bangkok AIDS Conference

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Update from Recent Scientific Conferences
Antiretroviral Issues
Roy M. Gulick, MD, MPH
The International AIDS SocietyUSA
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Global AIDS People living with HIV/AIDS, end
2003
Prevalence (Range)
Eastern Europe Central Asia 1.3 M (860,000-1.9
M)
Western Europe 580,000 (460,000-730,000)
North America 1.0 M (520,000-1.6 M)
East Asia Pacific 900,000 (450,000-1.5 M)
North Africa Middle East 480,000 (200,000-1.4 M)
Caribbean 430,000 (270,000-760,000)
S SE Asia 6.5 M (4.1-9.6 M)
Latin America 1.6 M (1.2-2.1 M)
Sub-Saharan Africa 25 M (23.1-27.9 M)
Australia New Zealand 32,000 (21,000-46,000)

• 38 M living with HIV/AIDS 50 women
• 4.8 M new HIV infections in 2003
• 2.9 M deaths due to HIV/AIDS in 2003

UNAIDS 2004 Report
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ART Resistance in Rx-Naïve Patients

• 1082 HIV-infected (no prior AIDS), rx-naïve
  patients from 39 sites in 10 U.S. cities (97-01)
• Underwent GT testing
• Overall, 8 had RT or PR mutations associated
  with resistance to ART
• 15 in those with sexual partners on ART

Weinstock, et al. JID 20041892174
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GS 934 Study

• Study population HIV-infected, treatment-naïve
  patients, VL gt10K (N517)
• Study treatment (ZDV/3TC or TDF/FTC) EFV

Gilead Press Release, 8/26/04
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ART Durability

• ABT 720 d4T 3TC LPV/r (5 years)
• Hicks, Bangkok 2004 abst WeOrB1291
• Dupont 006 ZDV/3TC EFV (3 years)
• Tashima, Bangkok 2004 abst TuPeB4547
• Gilead 903 TDF 3TC EFV (3 years)
• Gallant, Bangkok 2004 abst TuPeB4538
• Toro 1 2 OB enfuvirtide (2 years)
• Arastéh, Bangkok 2004 abst. MoOrB1058
• Class ABC 3TC d4T, EFV, or APV (2 years)
• Bartlett, Bangkok 2004 abst. TuPeB4544

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HIV Entry Mechanism
2. Co-receptor interaction
HIV
gp41
3a. Anchorage
HIV
1. CD4 Attachment
CXCR4 CCR5
CD4
gp41
Cell
3c. Fusion Complete
HIV
3b. coil-coil interaction
HIV
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Investigational Drugs 2004 (Newer Classes)

• Entry inhibitors
• CD4 attachment inhibitors
• BMS compounds PRO 542 TNX-355
• Chemokine receptor inhibitors
• CCR5 GW 873140 PRO 140 SCH 417690
• UK 427,857
• CXCR4AMD 070 KRH 2731
• Integrase inhibitors L-870810
• Budding/maturation inhibitors PA-457

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Maturation inhibitors
not treated
treated with PA-457
Li, et al. PNAS 200310013555