Challenges of HIV- The WHO estimates that more than 33 million people worldwide are infected with the HIV virus. One million of those are in the US, while more than three quarters are located in Sub-Saharan Africa. While the disease continues to spread, for those with access to antiretroviral therapy the prognosis has changed from a fatal disease to a long-term chronic condition. Since the introduction of the first protease inhibitor (PI)-based antiretroviral therapies in the 90’s, advancements in highly active antiretroviral therapy (HAART) have slowed progression of HIV/AIDS dramatically, from a median of 9 months before HAART to an average of 20 years.

Current HIV Treatment Landscape- Over the past decade, treatment has evolved to emphasize once daily regimens with significantly lower toxicities than early therapeutic regimens, and with much improve efficacy. HAART ‘cocktails’ now most often consist of three or more NRTIs, NNRTIs, and PIs, depending on the line of therapy, and new and expanding classes such as entry inhibitors are now being introduced. As such, the HIV drug market has grown significantly over the past decade and exceeded $10 billion in 2008.. The market will grow due to the development of cross-class fixed-dose combinations, longer life expectancies of HIV patients, and the high prevalence of HIV worldwide. Some estimates value the market at roughly $15 billion by 2017.

Future of the HIV Drug Market- Research and development efforts for future products are primarily focused on two key areas: vaccines and fixed-dose combination products. Resistance to classes of medications due to patient non-compliance are of serious concern to clinicians, so more fixed-dose combination therapies are being introduced with a view to improving compliance and sparing classes for later in the disease process. In addition, there are currently more than 400 ongoing or recently completed clinical trials related to development of an HIV vaccine. While trials have thus far not yielded particularly promising data, the idea holds promise as a vaccine would stem the spread of the disease and reduce healthcare costs significantly.