A	B	C	D	E	F
1	Main
2		HIV has a high genetic variability - high mutation rate resulting from short life cycle
3			will adapt to immune system + drugs
4			HIV has inevitably adapted to all monotherapies
5			combination therapy is the standard treatment for HIV
6				HAART - Highly Active Anti-Retroviral Therapy
7				preferred initial regimens are
8					efavirenz + lamivudine or emtricitabine + zidovudine or tenofovir
9					lopinavir boosted with ritonavir + zidovudine + lamivudine or emtricitabine
10
11		Guidelines: dHHS recommends Epizcom be used as an alternative (ACTG 5202?, DAD?)
12			JPM June 2009 comments: survey suggests high doctor sensitivity to dHHS. We see upside if CD4 recs move to <500.
13			NA-ACCORD data may influence change to guidelines.
14			EACS - European Body now recommending treatment from 350-500, previously was 350.
15
16		http://www.aidsmeds.com/List.htm
17		Reverse Transcriptase Inhibitors				target construction of viral DNA by inhibiting activity of reverse transcriptase
18		Nucleoside analog RTIs
19		generic	zidovudine/azidothymidine (Retrovir/Retrovis) - AZT/ZDV
20		GSK	abacavir (Ziagen) - ABC - all abacavir containing regimens have a total of 170k patients in the US/EU - GILD 11/08
21				most powerful NRTI
22				hypersensitivity reaction in under 10% of patients that results in sudden death
23				genetic test is available to test with reasonably accuracy who will be hypersensitive
24		BMY	didanosine (Videx) - ddI
25		RHHBY	zalcitabine (Hivid) - ddC
26				least potent NRTI
27		BMY	stavudine (Zerit) - d4T
28		GSK	lamivudine (Epivir) - 3TC
29		GILD	emtricitabine (Emtriva)
30
31		Nucleotide analog RTIs
32		GILD	tenofovir (Viread)
33
34			Non-nucleoside RTIs
35		Boehringer-Ingelheim	nevirapine (Viramune)
36		BMY	efavirenz (Sustiva)
37		PFE	delavirdine (Rescriptor)
38
39		Protease Inhibitors
40			prevent viral replication by inhibiting the activity of protease, an enzyme used by the viruses to cleave nascent proteins for final assembly of new virons
41			used in combination therapy for HIV
42
43		RHHBY	saquinavir (Fortovase)
44		ABT	ritonavir (Norvir)
45		MRK	indinavir (Crixivan)
46		PFE	nelfinavir (Viracept)
47		GSK	amprenavir (Agenerase)
48		ABT	lopinavir (Kaletra)
49		BMY	atazanavir (Reyataz)
50
51		Fusion Inhibitors
52			Fusion inhibitors block HIV from fusing with a cell's membrane to enter and infect it
53		Fuzeon
54
55		Integrase Inhibitors
56			inhibit the enzyme integrase, which is responsible for integration of viral DNA into the DNA of the infected cell
57		GS 9137
58		MK 0518
59
60		Maturation Inhibitors
61		PA 457
62
63		Cellular Inhibitors
64		Droxia	BMY	hydroxyurea
65
66		Antisense Antivirals
67
68
69		Reverse Transcriptase Inhibitors
70		Retrovir	GSK	zidovudine/azidothymidine (AZT, ZDV)
71			generic	zidovudine/azidothymidine (AZT, ZDV)
72		Ziagen	GSK	abacavir (ABC)
73		Videx	BMY	didanosine
74
75
76
77		Fixed-dose Combination Therapies
78		name	company	description
79		Combivir	GSK	AZT + 3TC
80		Trizivir	GSK	ABC + AZT + 3TC
81		Kaletra	ABT	lopinavir + ritonavir
82		Epzicom	GSK	ABC + 3TC
83		Kivexa	GSK
84		Truvada	GILD	emtricitabine + tenofovir
85		triple pill	GILD	emtricitabine + tenofovir +
86
87
88		China 700,000 infected with HIV and 85,000 with AIDS - 2007 Government statistics.
89		Most infections occur in rural areas where healthcare is not advanced. Lancet 2008.