Lenacapavir for HIV Infection in a Multidrug-Resistant Study Cohort

Article

Could lenacapavir be the answer for people with multidrug-resistant HIV infection? Principal investigator Sorana Segal-Maurer discusses the promising trial results in this challenging cohort (Interview part 1).

There have been myriad advances in HIV treatment options. Injectable, long-acting HIV therapies, once a pipe dream, are now approved and available.

However, treatments for people living with multidrug-resistant human immunodeficiency virus type 1 (HIV-1) are far more limited. People with difficult-to-treat HIV or a history of treatment failure have substantial treatment needs.

Lenacapavir, a first-in-class capsid inhibitor, has potential to fulfill this need. Today, research from the ongoing phase 3 CAPELLA trial was published in The New England Journal of Medicine. Sorana Segal-Maurer, MD, the principal investigator and lead author of the paper, sat down with Contagion to discuss the significance of these results.

This significance, Segal-Maurer says, largely stems from the study population, who had “pretty resistant virus and not a lot of options for its control.” Of the 72 patients enrolled, 1 in 5 had no fully active antiretrovirals available to them. “These were deeply multidrug-resistant HIV-infected patients,” said Segal-Maurer.

Additionally, the median age of the study population was 52 years, and the average time of HIV infection was 24 years. Treatment failure was common in this cohort, and Segal-Maurer said most had cycled through at least 9 to 11 antiviral agents.

The highly resistant HIV infections in this cohort makes the results all the more remarkable. “Study results can be very rosy if there’s not a lot of disease,” Segal-Maurer said. “But if you have terrific results and you have a really challenging population, I really think that speaks to the importance of the results.”

At week 14 of the study, 81% of participants were undetectable with a viral load of less than 50 copies per milliliter. Segal-Maurer notes that this change was sustained through week 26 of the study.

As a provider herself, Segal-Maurer highlighted the trial results that may be of great interest to other providers: “It’s good to be undetectable, but we want to see a rise in CD4 cells...that really leads to that decrease in opportunistic infections.”

Segal-Maurer emphasized, “EVERYONE who had profoundly decreased CD4 cells were able to get past that point, and I find that incredibly meaningful.”

Findings from the CAPELLA trial were originally presented at the 2021 Annual Conference on Retroviruses and Opportunistic Infections (CROI).

Sorana Segal-Maurer, MD, is Director of Infectious Diseases at New York-Presbyterian Queens and a professor of Clinical Medicine at Weill Cornell Medicine. She is the principal site investigator for the study, "Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection," published in The New England Journal of Medicine.

This is Part 1 of a 2-part interview with lead author and investigator Dr. Sorona Segal-Maurer. Come back tomorrow for Part 2!

Newsletter

Stay ahead of emerging infectious disease threats with expert insights and breaking research. Subscribe now to get updates delivered straight to your inbox.

Recent Videos
© 2025 MJH Life Sciences

All rights reserved.