Where options for an effective background antiretroviral regimen are few, enfuvirtide "should still be considered" as a means of "buying time" for new agents, the panel recommends in the consensus statement, published in the May 21st issue of AIDS.

The introduction of enfuvirtide represents "an important advance" in the management of highly treatment-experienced, HIV-infected patients, Dr. Bonaventura Clotet, of the Hospital Universitari Germans Trias i Pujol, Badalona, Spain and panel members note in the report. "However, parental self-administration and the advanced disease and antiretroviral experience of patients currently most needing enfuvirtide introduce unique considerations."

Principally a "salvage" medication at present, enfuvirtide has been shown to provide clinically meaningful improvements in CD4 cell counts and reductions in HIV viremia across "all subgroups of treatment-experienced patients," according to the panel.

The panel also recommends the use of resistance testing, when available, to guide the selection of background antivirals. "For preference, enfuvirtide should be used in those for whom sufficient residual drug activity remains to construct a background regimen that allows full virological response," they recommend.

The panel acknowledges that "more information is needed on enfuvirtude resistance, particularly the genotypic and phenotypic correlates of enfuvirtude response." However, it is their opinion that "until such data are available, and until potentially cross-resistant new agents advance through development, enfuvirtide resistance considerations should not influence clinical management."

Among the panel’s other recommendations are to provide ongoing training and support to enfuvirtide-treated patients to prevent "injection fatigue," boost adherence, and curb injection site reactions, which are common with enfuvirtide. "An initial investment in establishing such procedures can be expected to yield significant returns in patient confidence and benefit on enfuvirtide," the authors write.