Drug Cocktail Design For HIV Patients Is Extremely Important

The relationship between how accurately HIV patients take the drugs prescribed by their doctors and the chance of the virus developing drug resistance has been well known for quite some time. However, according to a new study by Harvard scientists, the relationship between faithfulness to a drug plan and resistance is different for each of the drugs that make up the "cocktail" used to fight against the disease.

In order to understand the reason those differences exist, and to help doctors quickly and cost-effectively design new combinations of drugs that have a lower chance of resulting in resistance, a team led by Martin Nowak, Professor of Mathematics and of Biology and Director of the Program for Evolutionary Dynamics, invented a technique that medical researchers can use to understand the effects of different drugs, and be able to predict if certain treatments will cause the virus to become resistant.

Alison Hill, a PhD student in Biophysics and co-first author of the paper published in Nature Medicine, said:

"What we demonstrate in this paper is a prototype for predicting, through modeling, whether a patient at a given adherence level is likely to develop resistance to treatment. Compared to the time and expense of a clinical trial, this method offers a relatively easy way to make these predictions. And, as we show in the paper, our results match with what doctors are seeing in clinical settings."

According to Nowak, the new technique will help scientists figure out exactly they need to do so they don't have to keep struggling with a trial-and-error process.

"This is a mathematical tool that will help design clinical trials," he explained. "Right now, researchers are using trial and error to develop these combination therapies. Our approach uses the mathematical understanding of evolution to make the process more akin to engineering."

However, large amounts of data are needed to make a model than can make these predictions accurately.

Hill and Daniel Scholes Rosenbloom, a Ph.D. student in Organismic and Evolutionary Biology and the paper's other first author, wanted to find that data. In order to do so, they turned to Johns Hopkins University Medical School, where Professor of Medicine and of Molecular Biology and Genetics Robert F. Siliciano was working with Ph.D. student Alireza Rabi (also co-first author) to learn how the HIV virus reacted to different drug dosages.

Since the level of the drug in patients, even in those that adhere to their treatment perfectly, naturally varies, the data was essential to the model that Hill, Rabi, and Rosenblood eventually created.

The virus is able to replicate and grow when drug levels are low (like they are between doses, or if the person misses a dose). Although higher drug levels keep the virus in check, they also heighten the chance of mutant strains of the virus emerging, which causes drug resistance.