Lenacapavir for HIV infection in a multidrug-resistant study cohort

There have been a myriad of advances in HIV treatment options. Long-acting injectable HIV therapies, once a pipe dream, are now approved and available.

However, treatments for people living with multidrug-resistant human immunodeficiency virus type 1 (HIV-1) are much more limited. People with hard-to-treat HIV or a history of treatment failure have significant treatment needs.

Lenacapavir, a first-in-class capsid inhibitor, has the potential to meet this need. Today, research from the ongoing CAPELLA Phase 3 trial was published in The New England Journal of Medicine. Sorana Segal-Maurer, MD, principal investigator and lead author of the paper, spoke with Contagion to discuss the significance of these results.

That significance, Segal-Maurer says, stems in large part from the population studied, which had “a fairly resistant virus and not many options for its control.” Of the 72 patients enrolled, 1 in 5 did not have fully active antiretrovirals available to them. “These were profoundly multidrug-resistant HIV-infected patients,” Segal-Maurer said.

In addition, the median age of the study population was 52 years and the average duration of HIV infection was 24 years. Treatment failure was common in this cohort, and Segal-Maurer said most had used at least 9 to 11 antiviral agents.

The highly resistant HIV infections in this cohort make the results all the more remarkable. “The study results can be very positive if there’s not a lot of disease,” Segal-Maurer said. “But if you have tremendous results and you have a really difficult population, I really think that speaks to the importance of results.”

At week 14 of the study, 81% of participants were undetectable with a viral load below 50 copies per milliliter. Segal-Maurer notes that this change was maintained through week 26 of the study.

As a provider herself, Segal-Maurer pointed to trial results that could be of great interest to other providers: “It’s good to be undetectable, but we want to see an increase in CD4 cells …which really leads to this decrease in opportunists. infections. »

Segal-Maurer pointed out, “EVERYONE who had deeply diminished CD4 cells was able to get past that point, and I find that incredibly significant.”

Results from the CAPELLA trial were originally presented at the 2021 Annual Conference on Retroviruses and Opportunistic Infections (CROI).

This is the first part of a two-part interview with lead author and researcher Dr. Sorona Segal-Maurer. Come back tomorrow for part 2!

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