IDSE Review
Updates in the Pipeline of HIV Therapy BY DANIEL A. SOLOMON, MD,
M
AND
JONATHAN Z. LI, MD, MMSC
odern antiretroviral therapy (ART) for HIV is well tolerated and highly effective. Most people with HIV (PWH) achieve virologic suppression with currently available options. So, where is the room for improvement? The recent advances in HIV therapy focus on new options for both treatment-naive and treatment-experienced patients, simplified drug regimens, and novel treatment strategies that do not rely on adherence to daily oral medication. In this article, we review the newest wave of ART, provide an update on 2-drug oral regimens, and discuss how treatment strategies may change with the approval of long-acting oral and injectable therapies.
The Most Exciting New Agents Recently Approved by the FDA Fostemsavir (FTR; Rukobia, ViiV Healthcare), the prodrug of temsavir, was approved in July 2020. FTR is a first-in-class glycoprotein 120 (gp120) attachment inhibitor that works by blocking viral attachment to the host CD4 cell. Compared with maraviroc (Selzentry, ViiV Healthcare), a CCR5 attachment inhibitor, it is active regardless of viral tropism, and there is no cross-resistance to any existing ART.1 The current role of FTR in HIV treatment is for patients with extensive antiviral resistance and limited therapeutic options. The BRIGHTE study was a phase 3 trial of patients experiencing virologic failure with multiclass resistance and no fully viable combination ART regimens available. When FTR was added to an optimized backbone for patients with 1 or 2 remaining active ART classes, 57% of individuals achieved a viral load less than 40 copies/mL at 48 weeks, compared with 45% in the placebo arm. For patients with no remaining antiretroviral options, 38% achieved a viral load less than 40 copies/mL at week 48, and participants demonstrated a mean increase in the CD4 cell count of 64 cells/mm3.2 FTR is an important addition to
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