Long-Acting ART, Islatravir, and Capsid Inhibitors
MAR 26, 2020 | CONTAGION® EDITORIAL STAFF
Segment Description: Ian Frank, MD, Professor of Medicine at the Perelman School of Medicine, University of Pennsylvania, discusses upcoming treatments for people with HIV.
Interview Transcript (modified slightly for readability):
Frank: We will soon have available to us the first injectable antiretroviral long acting combinations, injectable cabotegravir and rilpivirine. These are agents that will be given first as oral agents and then if tolerated and people have virologic suppression, we'll be able to switch them to injections that are given every 4 weeks, or maybe every 8 weeks, with a couple of intramuscular injections in their gluteus medius.
Unfortunately, people will have to come into our offices in order to get the shots and they'll need to adhere to the injection regimen at the desired frequency. These are long acting products and there is the concern that individuals who miss their injections are potentially at risk for developing resistance.
However, for people who don't like taking pills, or for people who associate the pill as a reminder of HIV infection, and stigma associated with that, we'll finally have an alternative for them that may help them adhere better. So, first injectable agents. We've got some other oral agents that are not as far along in development, further from the clinic. One called is islatravir is a drug that's like a nucleoside but has a couple of additional properties. It's called a nucleoside reverse transcriptase translocation inhibitor. This looks like a very potent drug that may be given once a week or may be able to be coformulated with another agent to have an effective 2-drug combination.
And then we've got, again further along, a capsid inhibitor. The capsid inhibitors work by inhibiting multiple steps in the HIV lifecycle. And it appears that the first agent to be tested in this class has a lot of activity at a very low dose, and may be formulated either in a pill that could be taken once a week or as another injection.
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