A new paradigm for antiretroviral delivery: long-acting cabotegravir and rilpivirine for the treatment and prevention of HIV.

IF 4.5 3区 医学 Q2 IMMUNOLOGY
Sara H Bares, Kimberly K Scarsi
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引用次数: 18

Abstract

Purpose of review: Cabotegravir (CAB) and rilpivirine (RPV) is the first long-acting injectable antiretroviral therapy (ART) option approved for virologically suppressed adults with HIV-1. In addition, long-acting CAB is a promising agent for HIV preexposure prophylaxis (PrEP). This review focuses on phase 3 clinical trial results and implementation considerations for these long-acting ART and PrEP strategies.

Recent findings: Long-acting CAB and RPV administered every 4 weeks demonstrated noninferiority to oral ART through week 96 in both the ATLAS and FLAIR studies, whereas ATLAS-2M found similar efficacy through 96 weeks when the long-acting injectable ART was administered every 8 weeks instead of every 4 weeks. For prevention, two phase 3 trials were stopped early due to fewer incident HIV infections in participants receiving long-acting CAB every 8 weeks compared with daily oral tenofovir disoproxil fumarate-emtricitabine for PrEP. The long-acting therapies were well tolerated across all clinical trials.

Summary: Clinical trial results support the use of long-acting CAB for HIV PrEP and long-acting CAB and RPV as a switch strategy for adults with HIV-1 who are first virologically suppressed with oral ART. Implementation challenges persist, and data are urgently needed in populations who may benefit most from long-acting therapy, including adolescents, pregnant individuals, and those with barriers to medication adherence.

Abstract Image

抗逆转录病毒递送的新范例:长效卡博特韦和利匹韦林用于治疗和预防艾滋病毒。
综述目的:Cabotegravir (CAB)和rilpivirine (RPV)是第一个被批准用于病毒学抑制的成人HIV-1患者的长效注射抗逆转录病毒疗法(ART)选择。此外,长效CAB是HIV暴露前预防(PrEP)的一种有前景的药物。本综述侧重于这些长效抗逆转录病毒治疗和PrEP策略的3期临床试验结果和实施考虑。最近的发现:在ATLAS和FLAIR研究中,每4周给药的长效CAB和RPV在96周内与口服ART无劣效性,而ATLAS- 2m在96周内的疗效与每8周给药的长效注射ART相似,而不是每4周给药。在预防方面,由于每8周接受长效CAB的参与者与每天口服富马酸替诺福韦二氧吡酯-恩曲他滨的PrEP相比,HIV感染发生率更低,两项3期试验提前停止。在所有临床试验中,长效疗法耐受性良好。摘要:临床试验结果支持将长效CAB用于HIV PrEP,并将长效CAB和RPV作为口服抗逆转录病毒药物首次病毒学抑制的成人HIV-1患者的切换策略。实施方面的挑战依然存在,迫切需要从长效治疗中获益最多的人群的数据,包括青少年、孕妇和有药物依从性障碍的人群。
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来源期刊
Current Opinion in HIV and AIDS
Current Opinion in HIV and AIDS IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
7.40
自引率
7.30%
发文量
115
审稿时长
6-12 weeks
期刊介绍: Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in HIV and AIDS features hand-picked review articles from our team of expert editors. With six disciplines published across the year – including HIV and ageing, a HIV vaccine, and epidemiology – every issue also contains annotated reference detailing the merits of the most important papers.
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