On Maraviroc

Maraviroc to me represents progress, I can faintly remember in my youth the news about the (then new) protease inhibitors and that mankind had finally found a way to stay (or perhaps more accruately subdue) the wild raging beast that was HIV/AIDS. To me, this new generation of treatment will be the "cure" of the disease.

Maraviroc has a simple formulation that has a binds highly selectively to the CCR5 also recently defined as CD195 "cluster of differentiation" 195. Upon binding to this chemokine receptor it blocks it! I don't know, ask a biochemical major. What I do know is that CCR5 is a corecepter used by HIV-1 to gain access into the cell. CCR5 is (coincidentally) present on all major classes of cells that HIV-1 infects - that is, CD4+ T cells, dendritic cells, microgliac, as well as macrophages. Studies in years past have shown that northern european men and women who had double homozygous mutations of the delta-32 gene (the gene that expresses CCR5) could not be infected by HIV-1. Indeed, a patient in Germany three years ago who had HIV as well as late stage leukemia was given a bone marrow transplant with a donor who had the delta-32 mutation. The operation was successful and the man has not had detectable levels of HIV.

The human body can no doubt live without a functional CCR5 chemokine receptor and as such it basically represents a naked vulnerability that must be perged, blocked, and destroyed. Ideally doctors could give bone marrow transplants to everyone - but of course even with modern technology a bone marrow transplant has a survival rate around 33% and donors are certainly not universal.

However, Maraviroc is universal. Studies have shown that it is highly tolerated with minimal side effects and with high binding efficiency. It was only recently released (2008 I believe) and so studies have not shown its efficiency when used as post prophylaxis treatment or as a general preventive drug.

However, theoretically and perhaps with a small dose of faith, I believe this drug can, will, and should be used for preventive care. If one is on a constant dose of this medication, the amount of cells an introduced HIV vector could potentially infect is dramatically lessened. If the virus is unable to achieve reproduction quickly enough the body will remove the inert substance by natural means - this is the theory behind current protease prophylaxis treatment. However, giving Maraviroc as a single pill at a precautionary dose is much more practical than the expensive combination of HAART preventative treatment and is without the severe side effects.

Unfortunately the second strain of the virus, HIV-2 predominatly located in west Africa does not use the CCR5 chemokine receptor and so maraviroc would be of little use. However, the theory should the same - the coreceptor is known for HIV-2 and a drug could be synthesized - perhaps outside of the united states where regulations are not so costly..

I've been working on a chemical compound using the same ideas from the maraviroc formulation - but without any means of testing and with very little current knowledge of biochemistry I feel it's hopeless. Also my general ignorance of pharmacuetical regulation. These problems can be remedied with time and effort. Perhaps I'll have to wait until medical school.

but the thoughts of the suffering. Pneumocytosis pneumonia, toxoplasmosis, ADC, induced cancers, tuberculosis, Kaposi sarcoma, Flu, rheumatic fevers - all multiplied in the thousands of people suffering.

One wonders if those who work on pharmaceuticals - the scientists not the businessmen - feel the collective pains, the souls in need of a hero. Does it keep them up at night?