IDSE Review
What’s New in HIV Therapy? BY HIND ALROWAIS, MD, AMY K. FEEHAN, PHD, AND JULIA GARCIA-DIAZ, MD
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n the United States, an estimated 1.2 million people are living with HIV infection and many remain undiagnosed.1 HIV testing is recommended at least once for individuals aged 13 to 64 years, including all pregnant women, and more frequently for high-risk individuals.2,3 Initiation of antiretroviral therapy (ART) at the time of diagnosis has been shown to suppress viral load and prevent HIV transmission, rapidly improving individual and public health outcomes.4,5 Delaying treatment in patients with AIDS-defining illness, acute HIV infection, or pregnant women is associated with increased risk for HIV transmission, morbidity, and mortality.6 However, there are some instances when delaying treatment is appropriate: if a patient is not ready to commit to starting medications or is experiencing certain opportunistic infections, such as cryptococcal infection or tuberculosis meningitis.7,8 People with nonmeningeal tuberculosis can initiate ART immediately,9 as well as those with many other opportunistic infections or malignancies.6
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IDSE.NET
New therapies for HIV continue to be developed; a private–public partnership was announced to accelerate the development of broadly neutralizing antibodies that can block the virus from invading cells.10 The FDA has just designated an experimental long-acting injectable, cabotegravir, as a breakthrough therapy for pre-exposure prophylaxis (PrEP).11 Several studies including GEMINI-1 and -2 have shown that sometimes less is more; 2-drug regimens are noninferior to 3-drug regimens and often have fewer side effects. New treatment options are beginning to be used clinically for experienced patients—the CD4 attachment inhibitors fostemsavir (Rukobia, ViiV Healthcare) and ibalizumab-uiyk (Trogarzo, Thera technologies). This article will discuss recent advancements in treatment and changing ideas on how to manage HIV.
