Antiretroviral therapy: new drugs, formulations, ideas, and strategies.

There is a continuing need for new antiretroviral drugs and formulations and updated strategies for using new and established drugs. Strategies being investigated for expanding initial treatment options include use of rilpivirine, raltegravir, or maraviroc as an alternative to efavirenz, use of pharmacokinetics enhancers without anti-HIV activity as an alternative to ritonavir as a boosting agent, and use of regimens sparing nucleoside analogue reverse transcriptase inhibitors, including ritonavir-boosted (/r) lopinavir plus raltegravir; darunavir/r plus raltegravir; vicriviroc plus atazanavir/r; and unboosted atazanavir plus raltegravir. For patients receiving fully suppressive regimens, strategies such as switching from lopinavir/r to raltegravir and from enfuvirtide to raltegravir have been examined. In highly treatment-experienced patients, use of 3 new active drugs has been found to be successful in suppressing virus. This article summarizes a presentation made by Joseph J. Eron, Jr, MD, at the International AIDS Society-USA continuing medical education program in Chicago in May 2009. The original presentation is available as a Webcast at www.iasusa.org.