Long-Acting HIV Treatment May Help Drug-Resistant Cases

Key Takeaways

• • A UCSF study found that long-acting lenacapavir plus cabotegravir maintained viral suppression in 46 people with HIV.
  • All participants achieved or maintained undetectable HIV viral loads during follow-up.
  • The combination may offer an alternative for people with resistance to certain antiretroviral drugs or difficulty taking daily medication.
  • Explore All Infectious Diseases CME Conferences & Online Courses

Long-Acting HIV Treatment Shows Promise for Drug-Resistant Infections

A long-acting HIV treatment combining lenacapavir and cabotegravir may offer another option for people living with drug-resistant HIV or facing challenges with daily medication, according to researchers at the University of California, San Francisco (UCSF). The findings could help clinicians address gaps in treatment for patients who cannot use certain established antiretroviral regimens.

Published October 8 in JAMA Network Open, the study examined outcomes among 46 people who received the two long-acting medications. Researchers reported sustained viral suppression throughout follow-up, providing encouraging evidence for a combination that has not yet received approval as an HIV treatment.

How Does the Lenacapavir and Cabotegravir Combination Work?

Long-acting antiretroviral therapy can reduce the need for daily pills by allowing patients to receive medication at longer intervals. The currently approved long-acting HIV treatment combines cabotegravir with rilpivirine. However, resistance to rilpivirine and related drugs can limit its suitability for some patients. Rilpivirine’s limited availability in low- and middle-income countries also presents access challenges.

The new approach replaces rilpivirine with lenacapavir, which targets HIV through a different mechanism. By combining these medications, clinicians may have another option for patients whose treatment choices are limited by drug resistance.

According to senior author Monica Gandhi, MD, MPH, a UCSF professor of medicine, clinicians have already begun using the combination, despite limited evidence to guide its use. The study provides additional clinical data to inform treatment decisions.

What Did the Study Find About Viral Suppression?

Researchers at UCSF’s Ward 86 HIV Clinic evaluated 46 people who received long-acting lenacapavir and cabotegravir. Nearly three-quarters had drug resistance that could limit the use of the approved cabotegravir-rilpivirine combination. More than half also had detectable HIV when they began treatment.

All participants with detectable HIV achieved viral suppression within 13 weeks. Those who already had the virus under control maintained suppression. After a median follow-up of nearly two years, all participants had undetectable HIV viral loads.

These findings suggest that the combination may help selected patients achieve or maintain HIV viral suppression, including those with limited treatment options. However, the study did not directly compare the regimen with other therapies, so the results do not establish its superiority over existing treatments.

What Do the Findings Mean for HIV Care?

The combination remains unapproved for HIV treatment, and larger clinical studies must establish its effectiveness and safety across broader patient populations. Researchers have planned two clinical trials to investigate the approach further.

Meanwhile, increasing global availability of lenacapavir and cabotegravir, alongside agreements supporting generic versions in many lower-income countries, could influence future access to long-acting HIV care.

For More Updates, Explore All Infectious Diseases CME Conferences & Online Courses

For HIV specialists, infectious disease physicians, pharmacists, and nurses, these findings highlight a potential treatment option for patients with drug resistance or difficulty maintaining daily medication routines. Until further evidence becomes available, clinicians should base treatment decisions on approved regimens, individual resistance profiles, and established HIV treatment guidance.

Source:

University of California – San Francisco