Abstract
Purposeof Review
To present the data surrounding three novel agents for the treatment and prevention of HIV infection.
Recent Findings
To date, non-inferiority in the efficacy of cabotegravir, islatravir, and lenacapavir has been seen in their respective ongoing clinical trials. Formulation specific adverse effects have been noted, especially injection site reactions; however, non-injection-related adverse effects remain minimal with very few leading to study discontinuation. Overall, participants who received long-acting injectable therapy for treatment or prevention have preferred it over oral antiretroviral therapy. Clinical data have supported long-acting cabotegravir’s approval for treatment and pre-exposure prophylaxis of HIV while islatravir and lenacapavir remain in investigation status.
Summary
The ongoing human immunodeficiency virus (HIV) epidemic mandates advancements in its prevention and treatment. The focus of antiretroviral therapy is shifting to long-acting therapies that provide decreases in frequency of administration, multiple mechanisms of action, and high barriers to resistance.
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References
HIV/AIDS [Internet]. [cited 2022 Jan 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/hiv-aids.
Statistics Overview | Statistics Center | HIV/AIDS | CDC [Internet]. 2021 [cited 2022 Jan 22]. Available from: https://www.cdc.gov/hiv/statistics/overview/index.html.
What’s New in the Guidelines | NIH [Internet]. [cited 2022 Jan 22]. Available from: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection/whats-new-guidelines.
Pre-Exposure Prophylaxis For The Prevention of HIV Infection In The United States - 2021 Update [Internet]. [cited 2022 Jan 22]. Available from: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf.
Cabenuva [package insert]. Research Triangle Park, NC: GlaxoSmithKline. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Cabenuva/pdf/CABENUVA-PI-PIL-IFU2-IFU3.PDF. Published January 2021.
Swindells S, Andrade-Villanueva JF, Richmond GJ, Rizzardini G, Baumgarten A, Masiá M, et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112–23.
Orkin C, Arasteh K, Górgolas Hernández-Mora M, Pokrovsky V, Overton ET, Girard PM, et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med. 2020;382(12):1124–35.
Orkin C, Bernal Morell E, Tan DHS, Katner H, Stellbrink HJ, Belonosova E, et al. Initiation of long-acting cabotegravir plus rilpivirine as direct-to-injection or with an oral lead-in in adults with HIV-1 infection: week 124 results of the open-label phase 3 FLAIR study. Lancet HIV. 2021;8(11):e668–78.
Overton ET, Richmond G, Rizzardini G, Jaeger H, Orrell C, Nagimova F, et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 48-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet Lond Engl. 2021;396(10267):1994–2005.
Jaeger H, Overton ET, Richmond G, Rizzardini G, Andrade-Villanueva JF, Mngqibisa R, et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 96-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet HIV. 2021;8(11):e679–89.
Vocabria [summary of product characteristics]. Amersfoort, Netherlands: Glaxo Wellcome, S.A. https://www.ema.europa.eu/en/documents/product-information/vocabria-epar-product-information_en.pdf.
Vocabria and Cabenuva [product information]. Abbotsford, VIC: ViiV Healthcare Pty Ltd. https://www.tga.gov.au/sites/default/files/auspar-cabotegravir-sodium-and-cabotegravir-rilpivirine-210503.pdf.
Apretude [package insert]. Research Triangle Park, NC: GlaxoSmithKline. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Apretude/pdf/APRETUDE-PI-PIL-IFU.PDF. Published December 2021
Cattaneo D, Gervasoni C. Pharmacokinetics and pharmacodynamics of cabotegravir, a long-acting HIV integrase strand transfer inhibitor. Eur J Drug Metab Pharmacokinet. 2019;44(3):319–27.
Markowitz M, Frank I, Grant RM, Mayer KH, Elion R, Goldstein D, et al. Safety and tolerability of long-acting cabotegravir injections in HIV-uninfected men (ECLAIR): a multicentre, double-blind, randomised, placebo-controlled, phase 2a trial. Lancet HIV. 2017;4(8):e331–40.
Landovitz RJ, Li S, Grinsztejn B, Dawood H, Liu AY, Magnus M, et al. Safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in low-risk HIV-uninfected individuals: HPTN 077, a phase 2a randomized controlled trial. PLoS Med. 2018;15(11): e1002690.
Landovitz RJ, Li S, Eron JJ, Grinsztejn B, Dawood H, Liu AY, et al. Tail-phase safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in HIV-uninfected adults: a secondary analysis of the HPTN 077 trial. Lancet HIV. 2020;7(7):e472–81.
Landovitz RJ, Donnell D, Clement ME, Hanscom B, Cottle L, Coelho L, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med. 2021;385(7):595–608.
Eshleman SH, Fogel JM, Piwowar-Manning E, Chau G, Cummings V, Agyei Y, et al. Characterization of human immunodeficiency virus (HIV) infections in women who received injectable cabotegravir or tenofovir disoproxil fumarate/emtricitabine for HIV prevention: HPTN 084. J Infect Dis. 2022 Mar 18;jiab576.
Truvada [package insert]. Foster City, CA: Gilead Sciences, Inc. https://www.gilead.com/~/media/files/pdfs/medicines/hiv/truvada/truvada_pi.pdf. Published June 2020.
Descovy [package insert]. Foster City, CA: Gilead Sciences, Inc. https://www.gilead.com/~/media/Files/pdfs/medicines/hiv/descovy/descovy_pi.pdf. Published January 2022.
Cambou MC, Landovitz RJ. Novel antiretroviral agents. Curr HIV/AIDS Rep. 2020;17(2):118–24.
Bleasby K, Houle R, Hafey M, Lin M, Guo J, Lu B, et al. Islatravir is not expected to be a victim or perpetrator of drug-drug interactions via major drug-metabolizing enzymes or transporters. Viruses. 2021;13(8):1566.
Schürmann D, Rudd DJ, Zhang S, De Lepeleire I, Robberechts M, Friedman E, et al. Safety, pharmacokinetics, and antiretroviral activity of islatravir (ISL, MK-8591), a novel nucleoside reverse transcriptase translocation inhibitor, following single-dose administration to treatment-naive adults infected with HIV-1: an open-label, phase 1b, consecutive-panel trial. Lancet HIV. 2020;7(3):e164–72.
Molina JM, Yazdanpanah Y, Afani Saud A, Bettacchi C, ChahinAnania C, DeJesus E, et al. Islatravir in combination with doravirine for treatment-naive adults with HIV-1 infection receiving initial treatment with islatravir, doravirine, and lamivudine: a phase 2b, randomised, double-blind, dose-ranging trial. Lancet HIV. 2021;8(6):e324–33.
Matthews RP, Patel M, Barrett SE, Haspeslagh L, Reynders T, Zhang S, et al. Safety and pharmacokinetics of islatravir subdermal implant for HIV-1 pre-exposure prophylaxis: a randomized, placebo-controlled phase 1 trial. Nat Med. 2021;27(10):1712–7.
Bester SM, Wei G, Zhao H, Adu-Ampratwum D, Iqbal N, Courouble VV, et al. Structural and mechanistic bases for a potent HIV-1 capsid inhibitor. Science. 2020;370(6514):360–4.
Clinical Evaluation Of Drug Interactions With Oral Lenacapavir And Probe Drugs [Internet]. CROI Conference. [cited 2022 Jan 22]. Available from: https://www.croiconference.org/abstract/clinical-evaluation-of-drug-interactions-with-oral-lenacapavir-and-probe-drugs/.
Marcelin AG, Charpentier C, Jary A, Perrier M, Margot N, Callebaut C, et al. Frequency of capsid substitutions associated with GS-6207 in vitro resistance in HIV-1 from antiretroviral-naive and -experienced patients. J Antimicrob Chemother. 2020;75(6):1588–90.
Link JO, Rhee MS, Tse WC, Zheng J, Somoza JR, Rowe W, et al. Clinical targeting of HIV capsid protein with a long-acting small molecule. Nature. 2020;584(7822):614–8.
Efficacy and safety of long-acting subcutaneous lenacapavir in phase 2/3 in heavily treatment-experienced people with HIV: week 26 results (Capella study) [Internet]. [cited 2022 Jan 22]. Available from: https://www.natap.org/2021/IAS/IAS_29.htm.
Long-acting lenacapavir in people with multidrug-resistant HIV-1: week 52 results [Internet]. [cited 2022 Apr 15]. Available from: https://www.natap.org/2022/CROI/croi_08.htm.
Gupta SK, Berhe M, Crofoot G, Sims J, Benson P, Ramgopal M, et al. Long-acting subcutaneous lenacapavir dosed every 6 months as part of a combination regimen in treatment-naïve people with HIV: interim 16-week results of a randomized, Open-label, Phase 2 Induction-Maintenance Study (CALIBRATE). 14.
Lenacapavir as part of a Combination regimen in treatment-naïve people with HIV: week 54 results [Internet]. [cited 2022 Apr 15]. Available from: https://www.natap.org/2022/CROI/croi_69.htm.
Gilead announces clinical hold on studies evaluating injectable lenacapavir for HIV treatment and prevention due to vial quality concerns [Internet]. [cited 2022 Jan 22]. Available from: https://www.gilead.com/news-and-press/press-room/press-releases/2021/12/gilead-announces-clinical-hold-on-studies-evaluating-injectable-lenacapavir-for-hiv-treatment-and-prevention-due-to-vial-quality-concerns.
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Fidelia Bernice has received speaker honorarium from Clinical Care Options. Christin Kilcrease declares that she has no conflict of interest.
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Bernice, F., Kilcrease, C. Novel and Investigational HIV Therapies for Treatment and Prevention: Focus on Cabotegravir, Islatravir, and Lenacapavir. Curr Infect Dis Rep 24, 89–96 (2022). https://doi.org/10.1007/s11908-022-00780-7
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DOI: https://doi.org/10.1007/s11908-022-00780-7