The success of an HIV treatment is based on convenience. The belief is that the more convenient the treatment, then the better the adherence will be, which in 
turn will reduce the potential of resistance developing.

When effective treatments first came on the market in the 1990s, patients needed to take 20-odd pills several times a day and also faced complicated food restrictions. 
Today the situation is very different. With 24 drugs available on the market, and regimens typically containing at least three of these drugs, the number of treatment combinations at a physician’s disposal appears endless.

Patients need to take 95% of their prescribed treatment in order to control the virus and prevent developing resistance to it. The emphasis and the pressure on pharmaceutical companies is to produce increasingly effective, tolerable and convenient pills. The current ideal is one pill a day.

Pharmaceutical companies have responded by bringing reformulations of existing products to market with a lower pill burden. Bristol Myers Squibb’s Sustiva, Pfizer’s Viracept, Hoffman-La Roche’s Invirase, GSK’s Epivir and Abbott’s Kaletra have gone down this route.

Others have focused on launching new products that only need to be taken once a day. These include Bristol Myers Squibb’s Reyataz and Gilead’s Viread and Emtriva. Gilead has combined Viread and Emtriva into a one-a-day combination (marketed as Truvada) as GSK has with Ziagen and Epivir (marketed as Epzicom or Kivexa). And Gilead and BMS in the United States have put aside commercial rivalry to market a once-a-day complete HIV regimen in a single pill. (Other products in the early stages of development are a dosing frequency of once per week, although these products are currently a long way from market.)

With so much competition and noise being generated as to who has the most efficacious and convenient treatment, pharmaceutical companies need to work hard to get their message across.
Bringing a drug to market is estimated to cost approximately US$800 million. As the HIV virus mutates and causes resistance to currently effective treatment, products have a short shelf life. This creates a need to produce a steady stream of new products and to ensure that the marketing is effective.

Pharmaceutical companies employ armies of specialist sales representatives to call on physicians on a regular basis or to organise educational meetings to convey the key benefits and clinical data associated with their product. Sales force expenditure often makes up one of the largest parts of the promotional budget, and pharmaceutical companies want to ensure they are using it as effectively as possible.

The key challenge for pharmaceutical companies is to determine the optimum promotional mix and this often means confirming the optimum sales force size needed. An intricate part of this is to determine the minimum number of sales calls required to initiate a prescription.

Once prescribed, it is essential to monitor the success of the latest production addition and whether the compliance and tolerability attributes are being well received by doctors and patients, and linked in with this is whether the dosing regimen is being adhered to.

And, of course, what the competition is saying about their own products and what, if anything, are they saying about their commercial rivals always remains of interest.

As the pressure mounts to provide even simpler HIV regimens, particularly with the launch of new classes such as integrase, maturation and attachment inhibitors, the focus will shift from one pill once a day to even more convenient regimens. The need will remain, however, for pharmaceutical companies to effectively market the product to doctors, while at the same time measuring how effective their messaging is, how credible doctors find it and, ultimately, the true benefit to the patient.