New kinds of treatment.

Everyone knows that patients urgently need new kinds of treatments (as well as better drugs in existing classes, mainly antiretrovirals). But it has always been hard to get new ideas developed. Almost by definition a new idea has not made money before, so the money people are not interested. Developing new drugs and new classes of drugs is expensive, due to the need to protect public health -- and because the system also reflects the need of large companies to monopolize the market and keep out small competitors.

Some of the lesser-known possibilities we intend to look at in 2002 include:

Topoisomerase inhibitors. In 1994 AIDS Treatment News reported on a class of drugs being developed for cancer, but not for HIV, though some experts believed they should be tested as antiretrovirals (see Topotecan, CPT-11 (Irinotecan), Camptothecin, and Other Topoisomerase I Inhibitors, AIDS Treatment News #197, April 15, 1994). Recently treatment activist Eric Goldman followed up and found that patent and policy snafus have apparently prevented these drugs from being tested and developed for HIV.

There seems to be a pervasive gap in drug development, where no one gets the first human data from a handful of patients (or even from one person). Government saves money by giving exclusive licenses to promising compounds tested in the laboratory -- but usually industry will not invest in human testing unless human proof of principle already exists. This appears to be a general problem that may have prevented many valuable treatments for AIDS and other conditions from ever coming into use.

In the specific case of topoisomerase inhibitors, some of these drugs have already been approved for cancer. Therefore it should be possible to watch viral load in persons treated for cancer who also have HIV. If there is substantial antiretroviral activity, it should be possible to restart the research that has been neglected for years.

Eric Goldman is preparing a comprehensive article on his investigation into why topoisomerase inhibitors were not researched for HIV; at this time (January 2002) only two short articles are available. The following are similar but not identical: http://www.thebody.com/sfac/topotecan.html http://www.searchforacure.org/hope/article.asp?sty=l6

Murabutide. This immune-based treatment, being developed in France, may strengthen the innate immune response -- which may also create conditions helpful for HIV-specific immunity.

Prostratin. This drug, from a tree in Samoa, may drive latent HIV out of hiding so that it can be targeted by other drugs or by the immune system.

Low-dose naltrexone. This potential treatment has been available for many years (AIDS Treatment News reported on it almost 15 years ago) but has not attracted much attention. We will cover it now because of anecdotal reports of people feeling better -- and also because there is little downside to using it. For the case in favor, see: http://www.lowdosenaltrexone.org.