Boone Lawrence R, Koszalka George W
Boone Consulting Services LLC, 4801 Abercroft Place, Fuquay-Varina, NC, USA
Curr Opin Investig Drugs. 2010 Aug;11(8):863-67.
The scarcity of new innovative drugs in the development pipeline for combating HIV replication may signal a change in direction for HIV researchers and drug developers. The model of introducing drugs with incremental improvements within existing drug classes is no longer commercially viable. While an argument can be made that drugs aimed at novel targets may have a greater impact, the list of such targets is limited and the scientific challenge of intervening at another stage in the HIV replication cycle is high. It is difficult to envision a realistic risk/reward scenario that will ensure continued investment in the discovery of novel HIV drugs that simply block replication and suppress plasma viral load. Recently, it has been suggested that the scientific community should move research in a new direction, with the goal of attacking the reservoirs of latent HIV that persist despite treatment with current drugs to achieve a functional cure, if not a sterilizing cure. This process will have to be a long-term commitment, primarily funded by the NIH, with some involvement by the pharmaceutical and biotechnology industries. While most individuals infected with HIV can achieve viral suppression with the current approved therapies, treatment is lifelong, side effects are significant and resistance will eventually render more of these drugs less effective. New and innovative approaches must be developed to prevent viral infection and further improve the quality of life for those individuals who are already infected.
用于对抗HIV复制的处于研发阶段的新型创新药物稀缺，这可能预示着HIV研究人员和药物研发人员的方向转变。在现有药物类别中引入逐步改进药物的模式在商业上已不再可行。虽然可以说针对新靶点的药物可能具有更大影响，但此类靶点的清单有限，且在HIV复制周期的另一个阶段进行干预面临的科学挑战很大。很难设想出一个现实的风险/回报方案，能确保持续投资于单纯阻断复制并抑制血浆病毒载量的新型HIV药物的研发。最近，有人建议科学界应将研究转向新方向，目标是攻克潜伏性HIV储存库，尽管使用现有药物进行治疗，这些储存库仍会持续存在，若不能实现彻底治愈，也要实现功能性治愈。这一过程将必须是一项长期投入，主要由美国国立卫生研究院（NIH）资助，制药和生物技术行业也会有所参与。虽然大多数感染HIV的个体通过目前批准的疗法能够实现病毒抑制，但治疗是终身的，副作用很大，而且耐药性最终会使更多此类药物效果降低。必须开发新的创新方法来预防病毒感染，并进一步改善那些已经感染HIV的个体的生活质量。
