"VX-950 is looking like a lock for the next SOC treatment ( for naives , at least )"
I think this statement is premature at this juncture. vx-950 is certainly off to a promising start, and at this early stage appears te effect greater reduction in VL than nm-283 (and probably protease inhibitors in general more active/effective, at least in short term than polymerase inhib). However, with respect to vx-950 in particular not enough patients have been dosed to assess both side effect profile and long-term suppression of VL (the latter of which may be an issue if the HIV protease inhibitor experience unfolds, in which protease inhibitors lead to the largest reduction of VL initially of any class of antiHIV infectives but are not sustainable (as monotherapy at least) due to drug resistance)
personally I see at least an equal potential for combination therapies even up front in tx naive population for the following reasons:
1. tolerance of combination therapy is likely to be acceptable (as in HIV)
2. good chance for an incremental benefit up front in efficacy, as at least some protease-resistant strains (which will account for some, albeit potentialy small numbers, of failures) will be susceptible to polymerase inhibitors
3. cross-resistance has been documented, which may argue for combination therapy up front as opposed to serially (that is treating failures subsequently with a polymerase inhibitor)
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