Codevelopment of new antiretrovirals in very treatment-experienced HIV-infected individuals.

A major clinical problem exists in the treatment of highly antiretroviral drug-experienced HIV-infected individuals with so-called salvage therapy. This group represents an ever increasing proportion of our patients and encompasses those at greatest risk of clinical disease. The availability of new therapies within existing classes of antiretrovirals— eg tipranavir—and of novel classes—eg enfurvitide the first fusion inhibitor—has greatly improved the options for these patients. However the pathophysiology of HIV and the available clinical trial data suggest the successful outcome of future combination therapy will be determined by the number of new drugs used as well as retained susceptibility to previous agents including some for which resistance mutations might be archived. (excerpt)