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The Role of Maraviroc in Antiretroviral Therapy for Treatment-Experienced Patients
  • Daniel R. Kuritzkes, MD
  • Section of Retroviral Therapeutics
  • Brigham and Women’s Hospital
  • Harvard Medical School
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Risk of Virologic Failure and HIV-1 Drug Resistance after starting ART
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Prevalence of antiretroviral drug resistance in US patients in care (1998)
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Prevalence of multidrug-resistant HIV
  • ~270,000 patients receiving ART in US1
  • ~10%-15% of treated patients are viremic and have triple-class drug resistance2
  • At least 25,000-40,000 patients could benefit from better options for treating drug-resistant HIV-13
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Changing goals of therapy in highly antiretroviral-experienced patients
  • Goals of therapy—20031
    • Preserve immune function
    • Maximize reduction in plasma HIV-1 RNA
    • Minimize toxicity


  • Goals of therapy—20062,3
    • Full viral suppression is an achievable goal
      • Newer drugs
      • Drugs in new classes
    • Use multiple active drugs to achieve full suppression
    • Minimize toxicity
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Why are CCR5 antagonists needed?
  • Many highly treatment-experienced patients have extensive resistance to drugs in existing classes


  • No single new drug is likely to have durable activity without additional active agents


  • Use of several new/active drugs necessary to achieve and maintain full suppression
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Changing goals of antiretroviral therapy in treatment-experienced patients
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Potential benefits of maraviroc
  • Potent inhibitor of R5 HIV-1 in highly treatment-experienced patients when combined with OBR


  • Safe and well-tolerated in studies to date


  • No demonstrated adverse consequences of administration to patients with D/M or X4 virus
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How should maraviroc be used?
  • Maraviroc should be used in combination with other active drugs in antiretroviral treatment-experienced patients with R5 virus