HIV Therapy: Prescription trends, Markets and Unmet Needs
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Infectious diseases and Respriatory pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the HIV market - page 4
- Related reports - page 6
- Upcoming reports - page 6
- CHAPTER 2 INTRODUCTION AND SCOPE - page 8
- Coverage of the Stakeholder Insight Survey - page 8
- Disease definition & epidemiology - page 8
- Diagnosis and treatment rates - page 8
- Treatment options and trends - page 8
- Key prescribing influences - page 9
- Improving treatment outcomes and new product development - page 9
- Coverage of the Stakeholder Insight Survey - page 8
- CHAPTER 3 COUNTRY TREATMENT TREES - page 10
- Introduction - page 10
- US - page 11
- France - page 13
- Germany - page 15
- Italy - page 17
- Spain - page 19
- UK - page 21
- Introduction - page 10
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 23
- Disease definition - page 23
- Etiology - page 24
- Disease prevalence - page 27
- HIV prevalence in the six major markets - page 27
- Epidemiological trends - page 27
- Patient segmentation - page 30
- By treatment experience - treatment-naïve and treatment-experienced population - page 30
- Pre- or post-HAART patients - page 31
- Number of resistance mutations - page 34
- Disease definition - page 23
- CHAPTER 5 DIAGNOSIS AND TREATMENT RATES - page 40
- Presentation and diagnosis - page 40
- Diagnostic tests - page 41
- Genotypic and phenotypic testing for resistance - page 43
- Genotypic assays - page 43
- Phenotypic assays - page 44
- Awareness campaigns have increased diagnosis rates - page 47
- Treatment rates - page 48
- CD4 T cell count - page 48
- Viral load - page 50
- Factors influencing the initiation of treatment - page 52
- Presentation and diagnosis - page 40
- CHAPTER 6 TREATMENT OPTIONS AND TRENDS - page 55
- Treatment options - page 55
- Nucleoside reverse transcriptase inhibitors (NRTIs) - page 56
- Non-nucleoside reverse transcriptase inhibitors - page 58
- Protease inhibitors - page 59
- Entry inhibitors - page 60
- Prescribing trends - page 61
- First-line therapy - page 63
- Second-line therapy - page 69
- Third-line therapy - page 72
- Fourth-line therapy - page 76
- Fifth-line to salvage therapy - page 78
- Treatment failure and switching therapy - page 81
- Resistance - page 84
- Compliance issues - page 84
- GI side effects - page 85
- Adverse lipid effects - page 86
- Lipodystrophy - page 86
- Dyslipidemia - page 87
- Renal dysfunction - page 87
- CNS side effects - page 88
- Drug interactions - page 88
- Hyperbilirubinemia and jaundice - page 89
- Pregnancy - page 89
- Treatment options - page 55
- CHAPTER 7 PRESCRIBING INFLUENCES AND BRAND ASSESSMENT - page 91
- Factors influencing physician decision making - page 91
- Efficacy - page 93
- Patient resistance profile - page 94
- Clinical trial data - page 95
- Quality of life considerations - page 96
- Pill burden and dosing frequency - page 96
- Side effects - page 97
- Treatment guidelines/hospital protocol - page 98
- Preservation of options for later lines of therapy - page 101
- Cost - page 102
- Physician perception of key brands - page 103
- Fixed dose combinations - page 103
- Protease inhibitors - page 106
- Factors influencing physician decision making - page 91
- CHAPTER 8 IMPROVING TREATMENT OUTCOMES AND NEW PRODUCT DEVELOPMENT - page 112
- Treatment outcomes - page 112
- Unmet needs - page 113
- Resistance remains the key unmet need for antiretroviral therapy - page 113
- Toxicity - page 114
- Unmet needs for FDCs and PIs - page 115
- New product development - page 115
- Awareness - page 116
- TMC125 and TMC278 - page 117
- MK-0518 (raltegravir) - page 121
- GS-9137 (elvitegravir) - page 124
- Selzentry/Celsentri (maraviroc) - page 126
- Vicriviroc - page 129
- BIBLIOGRAPHY - page 133
- Journals - page 133
- Websites - page 136
- Other - page 137
- APPENDIX A - page 142
- Physician research methodology - page 142
- Physician sample breakdown - page 142
- US - page 142
- France - page 143
- Germany - page 143
- Italy - page 144
- Spain - page 144
- UK - page 145
- Contributing experts - page 146
- Physician research methodology - page 142
- APPENDIX B - page 147
- The survey questionnaire - page 147
- Epidemiology and Patient Segmentation - page 147
- Diagnosis - page 148
- Treatment - page 149
- Product Profiles - page 175
- Products In Development - page 180
- Demographics - page 182
- Name of opinion leader - page 184
- Hospital - page 184
- Hospital City/Address - page 184
- Disclaimer - page 185
- List of Tables
- Table 1: HIV infected population in the six major markets, 2005 - page 27
- Table 2: HIV infections by transmission category in the US, 2005 - page 28
- Table 3: Overview of the nucleoside reverse transcriptase inhibitors, 2007 - page 57
- Table 4: Overview of the NNRTIs, 2007 - page 58
- Table 5: Overview of currently marketed PIs, 2007 - page 60
- Table 6: Overview of the FDCs - page 65
- Table 7: Overview of top five first-line regimens selected by physicians across the six major markets, 2007 - page 68
- Table 8: Overview of top five second-line regimens selected by physicians across the six major markets, 2007 - page 71
- Table 9: Overview of the top five drug regimens for third-line therapy, as selected by physicians, 2007 - page 75
- Table 10: Overview of the top five drug regimens for fourth-line therapy, as selected by physicians 2007 - page 77
- Table 11: Overview of the top five drug regimens for fifth-line-salvage therapy, as selected by physicians 2007 - page 80
- Table 12: HIV treatment guidelines available for the six major markets, 2007 - page 99
- Table 13: Level of awareness of developmental compounds, 2007 - page 116
- Table 14: Probable line of therapy upon launch for developmental compounds, 2007 - page 117
- Table 15: Probable line of therapy upon launch for TMC125, 2007 - page 119
- Table 16: Probable line of therapy upon launch for TMC278, 2007 - page 121
- Table 17: Probable line of therapy upon launch for raltegravir, 2007 - page 124
- Table 18: Probable line of therapy upon launch for elvitegravir, 2007 - page 126
- Table 19: Probable line of therapy upon launch for Selzentry, 2007 - page 129
- Table 20: Probable line of therapy upon launch for vicriviroc, 2007 - page 132
- Table 21: US physician sample breakdown, 2007 - page 142
- Table 22: France physician sample breakdown, 2007 - page 143
- Table 23: Germany physician sample breakdown, 2007 - page 143
- Table 24: Italy physician sample breakdown, 2007 - page 144
- Table 25: Spain physician sample breakdown, 2007 - page 144
- Table 26: UK physician sample breakdown, 2007 - page 145
- List of Figures
- Figure 1: Treatment tree for US part A - page 11
- Figure 2: Treatment tree for US part B - page 12
- Figure 3: Treatment tree for France part A - page 13
- Figure 4: Treatment tree for France part B - page 14
- Figure 5: Treatment tree for Germany part A - page 15
- Figure 6: Treatment tree for Germany part B - page 16
- Figure 7: Treatment tree for Italy part A - page 17
- Figure 8: Treatment tree for Italy part B - page 18
- Figure 9: Treatment tree for Spain part A - page 19
- Figure 10: Treatment tree for Spain part B - page 20
- Figure 11: Treatment tree for UK part A - page 21
- Figure 12: Treatment tree for UK part B - page 22
- Figure 13: Regional HIV and AIDS overview, 2006 - page 24
- Figure 14: HIV lifecycle - page 25
- Figure 15: Trends in routes of transmission in the US, 2001-05 - page 28
- Figure 16: Number of newly diagnosed cases of HIV infection by transmission group and year of report in Western Europe (13 countries), 1998-2005 - page 29
- Figure 17: Percentage of treatment-naïve and treatment-experienced HIV patients, 2007 - page 30
- Figure 18: Response to treatment in the first year of HAART, 1996-2002 - page 32
- Figure 19: United Kingdom CHIC study: extensive risk of failure - page 33
- Figure 20: Primary drug resistance in the US: March 2003-October 2006 - page 35
- Figure 21: Mutations that affect susceptibility to NRTIs - page 36
- Figure 22: Mutations that affect susceptibility to NNRTIs - page 37
- Figure 23: Mutations that affect the susceptibility to PIs - page 38
- Figure 24: PI resistance across the six major markets, 2007 - page 39
- Figure 25: Percentage of total HIV-infected population that is successfully diagnosed, 2007 - page 41
- Figure 26: Advantages and disadvantages of genotypic and phenotypic assays - page 45
- Figure 27: Factors that influence resistance testing in patients, 2007 - page 46
- Figure 28: Resistance testing by country, 2007 - page 47
- Figure 29: Newly diagnosed patients versus follow-up, 2007 - page 51
- Figure 30: Percentage of treatment-naïve and treatment-experienced HIV patients, 2007 - page 51
- Figure 31: CD4 counts at which therapy is initiated, 2007 - page 53
- Figure 32: Other criteria used by physicians to initiate treatment, 2007 - page 54
- Figure 33: Overview of sales by class,2002-06 - page 55
- Figure 34: Timeline of the development of the HIV market, 1985-2015 - page 56
- Figure 35: Percentage of patients receiving each line of therapy, 2007 - page 63
- Figure 36: FDCs reduce pill burden - page 66
- Figure 37: Mean percentage of patients receiving each first line regimen - page 69
- Figure 38: Mean percentage of patients receiving each second-line regimen - page 72
- Figure 39: Mean percentage of patients receiving each third-line regimen - page 76
- Figure 40: Mean percentage of patients receiving each fourth-line regimen - page 78
- Figure 41: Mean percentage of patients receiving each fourth-line regimen - page 81
- Figure 42: Reasons for switching HIV therapy, 2007 - page 83
- Figure 43: Factors influencing prescription choice for first to third lines of therapy, 2007 - page 92
- Figure 44: Factors influencing prescription choice from fourth-line onwards, 2007 - page 93
- Figure 45: Overview of recommendations given by US and UK guidelines - page 100
- Figure 46: Brand map for fixed dose combinations, 2007 - page 104
- Figure 47: Brand map for protease inhibitors, 2007 - page 107
- Figure 48: Combined brand map for protease inhibitors and fixed dose combinations, 2007 - page 110
- Figure 49: Drug classes most likely to be used in combination with TMC125, 2007 - page 118
- Figure 50: Drug classes most likely to be used in combination with TMC278, 2007 - page 120
- Figure 51: Drug classes most likely to be used in combination with raltegravir, 2007 - page 122
- Figure 52: Drug classes most likely to be used in combination with elvitegravir, 2007 - page 126
- Figure 53: Drug classes most likely to be used in combination with Selzentry - page 128
- Figure 54: Drug classes most likely to be used in combination with vicriviroc, 2007 - page 131
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