Clinical trials for heavily pretreated patients: update in 2006.
OBJECTIVE
To report on recent clinical studies in highly experienced patients with multiple exposures and failures to therapies using new drugs - either new drugs with a different resistance profile or a new class of drugs.


RESULTS
The major concern in a situation of salvage therapy is the capacity to build an antiretroviral regimen with sufficient potency to circumvent the intensity of viral replication and resistance of the virus. New drugs represent the major weapon in that fight. Several drugs have been developed in the past few years that have allowed a change in the paradigm for salvage therapy. They belong either to the old class of protease inhibitors but have been designed to target resistant viruses (tipranavir, darunavir), or to a new class such as fusion inhibitors, entry co-receptor inhibitors or integrase inhibitors.


CONCLUSIONS
Due to their potency and their ability to combine in a salvage regimen, the new drugs have allowed us to revisit the paradigm for managing treatment failure. Until recently it was estimated that one log drop in viral load was acceptable as the primary endpoint in salvage studies. Recent results now suggest that undetectability of the viral load has become a realistic target.
Katlama
Christine
C
University Pierre et Marie Curie Paris VI, Hopital Pitié-Salpetriere, Paris, France.
Ghosn
Jade
J