A once-weekly oral regimen of lenacapavir and islatravir can keep HIV suppressed for a year, researchers reported at IDWeek 2024. Gilead Sciences’ lenacapavir, an HIV capsid inhibitor, remains active against highly resistant virus. Injectable lenacapavir (Sunlenca) is approved as a twice-yearly treatment for people with multidrug-resistant HIV. Merck’s Islatravir is an experimental nucleoside reverse transcriptase translocation inhibitor.

 

Amy Colson, MD, MPH, of the Community Resource Initiative in Boston, and colleagues conducted a Phase II trial to test an oral version of lenacapavir plus islatravir pills administered once weekly as a switch option for people on daily Biktarvy pills (bictegravir/tenofovir alafenamide/emtricitabine). The study enrolled 104 adults with an undetectable viral load and no history of virological failure.

 

Earlier this year, Colson reported that switching to the weekly regimen worked as well as staying on daily pills at 24 weeks. At IDWeek, she reported that the experimental combination remains effective at 48 weeks. The viral suppression rate was 94.2% in the lenacapavir plus islatravir group versus 92.3% in the Biktarvy group. Both regimens were safe and generally well tolerated. Islatravir was put on a clinical hold in 2021 after higher doses led to CD4 cell and overall lymphocyte declines in earlier clinical trials, but this was no longer the case using the lower dose in this study.

 

Gilead and Merck are developing a combination pill containing lenacapavir and islatravir, which could become the longest-acting regimen without injections. “The future of HIV treatment is person-centered, with long-acting options tailored to help meet the needs and preferences of people affected by HIV,” says Gilead senior vice president Jared Baeten, MD, PhD.