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However, NNRTIs have an Achilles' heel: cross resistance. The cross resistance that exists between the currently available NNRTIs -- nevirapine (NVP, Viramune), delavirdine (DLV, Rescriptor) and efavirenz (EFV, Sustiva, Stocrin) -- gives patients and practitioners only one shot at the use of this class of drugs. As patients live longer on HAART and the pool of NNRTI-resistant viruses increases, so does the need for the development of new, second-generation NNRTIs with antiviral activity against both wild-type and the clinically prevalent NNRTI-resistant strains.

E. Wardrop from Boehringer Ingelheim presented in vitro data on BILR 355 BS, an NNRTI in development that has potent in vitro antiviral activity against a wide range of recombinant NNRTI-resistant viruses (EC50 < 10 nM). Past research has shown excellent pharmacokinetic and safety characteristics for this drug in small phase 1 trials in healthy volunteers.1 Initial studies with viruses resistant to currently available NNRTIs also support its continued development.2 The study presented by Wardrop at this conference further explored the mutational pathways that may reduce a patient's susceptibility to BILR 355 BS. Clade B HIV virus, the most common clade in the developed world, was examined, as were the non-clade B viruses found in the developing world. In addition, HIV-1 groups M and O, as well as HIV-2, were all tested for susceptibility to BILR 355 BS.

Wild-type and NNRTI-resistant HIV-1 were passaged in C8166 cells in the presence of BILR 355 BS. Inhibition of both wild-type and NNRTI-resistant virus containing emergent reverse transcriptase (RT) mutations was determined by p24 antigen assay.

Viral replication capacities were determined by luciferase expression in infected Jurkat-LTR-luciferase cells. ViroLogic PhenoSense methodology or p24 antigen assay was used to determine BILR 355 BS's antiviral activity against a panel of clinical isolates of wild-type group M HIV-1 (including clades A, B, C, D, F, G and H) and HIV-2. All clinical isolates were from treatment-naive patients, in order to minimize the potential for treatment-emergent resistance mutations. Group O isolates harbor naturally occurring polymorphisms, which may confer NNRTI resistance.

The chart below displays the antiviral profile of BILR 355 BS against recombinant viruses harboring the most commonly observed clinical resistance mutations. The data show that these mutations generally have a minimal impact on BILR 355 BS compared to nevirapine and efavirenz (mutations with minimal impact compared to wild-type virus are shown in bold). However, reduced susceptibility was seen with the Y188L and Y181C/ G190A mutations
 

 

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