IDSE Review
Cutting-Edge Issues In HIV Clinical Management: No End to the Dynamism of HIV Medicine BY RAJESH T. GANDHI, MD
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he field of HIV medicine continues to be dynamic and innovative, even after 40 years since the first reports of AIDS. In 2021, we saw major advances, including the approval of the first injectable long-acting antiretroviral regimen, new insights into how to treat patients who have had virologic failure, a better understanding of HIV treatment during pregnancy, an appreciation for the interaction between HIV and COVID-19, and continued progress in our knowledge of comorbidities and coinfections. Here, we review some of the highlights of the year in HIV clinical management from recent conferences.
Antiretroviral Therapy: The First Long-Acting HIV Regimen In 2021, the FDA approved CAB/RPV, the first long-acting injectable regimen for the treatment of HIV. The approval of this dosage regimen of every 4 weeks was based on 2 phase 3 clinical rials—ATLAS and FLAIR—which demonstrated that monthly injections of CAB/RPV were able to maintain virologic suppression in people with HIV at rates similar to that of oral daily antiretroviral therapy (ART).1,2 In another advance, the ATLAS-2M trial demonstrated that CAB/RPV every 8 weeks was comparable with a dosage of every 4 weeks in terms of maintaining virologic suppression.3 At the 2021 Conference on Retroviruses and Opportunistic Infections, week 96 data from ATLAS-2M were presented: 91% of those receiving the regimen every 8 weeks and approximately 90% of those receiving it every 4 weeks had HIV RNA less than 50 copies/mL.4 These data support the recent filing with the FDA for a CAB/RPV dosage regimen of every 8 weeks; we eagerly await the FDA’s decision regarding this dosage interval. What are the risk factors for virologic failure developing in people receiving CAB/RPV? In a separate analysis,
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