Lenacapavir and cabotegravir combo controls resistant HIV

Forty-six individuals with drug-resistant HIV achieved sustained viral suppression using a long-acting combination of lenacapavir and cabotegravir, according to research conducted by the University of California - San Francisco. The study, published Oct. 8 in JAMA Network Open, indicates this pairing may offer an alternative for patients who cannot tolerate daily pills or whose virus resists standard treatments.

Study details on resistant cases

Researchers at UCSF's Ward 86 HIV Clinic enrolled participants who received injections of both drugs weeks or months apart. Nearly three-quarters of the group possessed resistance patterns that typically restrict the use of the currently approved long-acting regimen, which pairs cabotegravir with rilpivirine. More than half of the subjects had detectable levels of HIV upon entering the trial.

All participants who began with detectable viral loads reached control within 13 weeks. Those already under control maintained that status throughout the observation period. After a median follow-up lasting nearly two years, every subject continued to exhibit undetectable HIV viral loads, meeting the primary therapeutic goal.

Limitations and future trials

The findings do not constitute regulatory approval for this specific combination as an HIV treatment. Additionally, the study did not include a direct comparison against other existing therapies. Monica Gandhi, MD, MPH, senior author and UCSF professor of Medicine, noted that clinicians have begun using these two drugs together despite limited evidence. She stated that this cohort represents the largest group studied on this combination, potentially giving providers more confidence in its application.

Two clinical trials are planned to further investigate the approach. The current funding came from the National Institutes of Health. Long-acting treatments provide an option for people struggling with daily medication adherence. However, rilpivirine, part of the only approved long-acting combination, faces availability issues in low- and middle-income countries and can encounter resistance. Lenacapavir attacks HIV through a different mechanism, replacing rilpivirine in this new protocol.