Virologic Outcomes With Lenacapavir in People With Human Immunodeficiency Virus: A Multicenter Real-World Study

Area of Science:

• Infectious Diseases
• Virology
• Pharmacology

Background:

• Lenacapavir (LEN), a novel long-acting HIV-1 capsid inhibitor, demonstrates potent antiviral activity.
• Real-world data on LEN use in heavily treatment-experienced people with HIV (PWH) is limited.
• This study assesses outcomes of LEN-based regimens in a US-based HTE PWH cohort.

Purpose of the Study:

• To evaluate the virologic response to lenacapavir in a real-world setting.
• To assess the impact of lenacapavir on regimen potency and pill burden.
• To determine the tolerability of lenacapavir-based regimens in heavily treatment-experienced individuals.

Main Methods:

• Retrospective cohort study of adults with HIV initiating LEN across 6 US clinics.
• Data abstraction from electronic health records, including demographics, clinical data, and genotypes.
• Virologic suppression defined as HIV viral load <200 copies/mL; genotypic susceptibility scores (S-GSS) used to assess potency.

Main Results:

• Seventy PWH initiated LEN, with a median follow-up of 12 months.
• Among 38 PWH with unsuppressed virus at baseline, 89% achieved viral suppression with LEN.
• LEN significantly improved regimen potency (P < .00005) and reduced daily pill burden (P < .00005).
• Injection site reactions occurred in 30% of patients, leading to discontinuation in one case.

Conclusions:

• LEN-based regimens achieve high virologic suppression rates in a real-world HTE PWH cohort.
• LEN improves regimen activity and reduces pill burden, demonstrating good tolerability.
• LEN shows promise as a salvage therapy, supporting its integration into HIV care.