Genes (made of DNA) are like instruction manuals for how to make the proteins that build our bodies and carry out our body functions. We have thousands of different types of proteins. Some are structural, like the protein collagen that makes up our skin.
Other proteins include enzymes, which control all of the reactions that take place in our bodies. Through the proteins that come from our genes, all aspects of our bodies are determined, like whether we can be tall or short, the complexion of our skin, color of our eyes, texture of our hair, how we digest food and process nutrients and the potential for disease. Viruses have genes too. Viruses are so simple that they may have just a handful of genes while we have thousands. But viruses have no way to reproduce themselves and their genes, so they hijack our cells and make them do it.
Two proteins from HIV genes that help the virus infect our cells are targets of the new drug combinations. The reverse transcriptase is an enzyme that the HIV virus produces that makes copies of HIV genes (DNA). Then, the HIV genes get inserted into our own genes by an HIV enzyme called integrase. This is how our cells can make the virus’s proteins when we make our own proteins.
Juluca is a combination of two powerful drugs. Rilpivirine blocks reverse transcriptase and Dolutegravir block integrase. This is a new concept because most HIV treatments have combined three different drugs. This is the first product to combine only two drugs as a complete regimen, but because these two drugs are so strong, they seem to work as well as three-drug combos.
Using two drugs instead of…
…three could have some advantages. It may allow patients to have more effective drugs to use in the future in case the regimen stops working. Remember that patients are going to be getting treated for 30-40 years or more, so they need to have effective options in the future. Also, fewer drugs may mean fewer side-effects and patients may stay on their treatment.
A new drug that blocks the integrase was approved called Bictegravir. It works the same way as Dolutegravir and is also very potent. Three drugs, including Bictegravir and two drugs that block reverse transcriptase (tenofovir-alafenamide and emtricitabine), are combined into a single pill called Biktarvy.
Just a few days ago (March 6, 2018), the FDA approved a new treatment that works differently from any other drug classes in preventing HIV. Ibalizumab (Trogarzo) is a monoclonal antibody. It recognizes the special site on your white blood cells that HIV attaches to when it infects cells. When Ibaluzimab is in the blood, it blocks this site and prevents HIV from getting into the cells to infect them.
There are other drugs that block the entry of HIV into cells but this drug works slightly differently. Because it is an antibody, it cannot be taken orally like a pill but must be injected under the skin, similar to how a diabetic person takes insulin. Fortunately, the injections only need to be given once every two weeks. Ibalizumab is a very important drug because it is specifically to be used in patients who have very few treatment options.
Individuals who have had HIV for a long time may be resistant to many of the classes of drugs available. Because this drug works differently from all other drugs, there should be no resistance and it may work together with other drugs to completely suppress the virus.
If you want to learn more about these new medicines and find out if they could help you, talk to your healthcare provider.
Dr. Crawford received a B.S degree in Biology from Cornell University and a B.S. in Pharmacy from Temple University. He completed a residency in clinical pharmacy at the National Institutes of Health. He earned a doctorate in Pharmacology from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He completed a post-doctoral fellowship at the National Institutes of Health, studying microbial biochemistry and genetics.
He is currently with the Division of AIDS at the National Institutes of Health. He has over 25 years of experience in HIV treatment and clinical research. This article reflects his personal views and opinions.
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