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Combined use of ibalizumab and lenacapavir for
the treatment of multidrug-resistant HIV-1: A case series Open Access
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Download the PDF here
Download the PDF here
Download the PDF here
Charlotte Rolle, MD1; Amit Achhra, MD2; Christina Harbison, PharmD3; Diana Finkel,
DO4; Christopher Lucasti, DO5; Claudia Martorell, MD6; Tammie McClendon, NP7; Jihad
Slim, MD8
03 November 2025
Most promising was the percentage of patients (42.8%) with baseline VL >200 or 400 copies/mL who achieved VL <50 copies/mL after
treatment with combined IBA + LEN. For some of these patients, the treatment provided an extended period of viral suppression that had not been achieved in years of follow-up. Likewise, increases in CD4+ count were noted across most patients, although it was not always possible to evaluate the clinical significance of these changes.
Abstract
Background
Some individuals with human immunodeficiency virus (HIV) have acquired multidrug-resistant (MDR) strains of HIV and/or are nonadherent to antiretroviral (ARV) medication. Injectable ARVs can provide salvage therapy for those with limited therapeutic options, and may be preferred by some people with HIV (PWH). Real-world evidence may contribute to a more comprehensive understanding of the barriers to adherence and the utility of injectable ARVs in PWH. Currently there is a lack of data on combined use of injectable ibalizumab (IBA) and lenacapavir (LEN) with optimized background regimen (OBR).
Methods
A retrospective observational study examined medical charts from people living with MDR HIV-1 across eight facilities in the USA. All PWH used a combination of both IBA + LEN ± OBR for at least 6 months. Viral loads (VL) and CD4+ counts were collected.
Results
A total of 21 PWH were included. Four-class resistance at baseline was reported in 38.1% of PWH. Within 12–24 weeks of combined IBA + LEN treatment, a median reduction of –2,710 copies/mL HIV-1 RNA was observed. Median increase to CD4+ count was 67.5 cells/mm3 within 4–44 weeks of treatment initiation. Few intolerances required changes to treatment. Therapy with IBA + LEN continued for an average of 30 months and 20 months, respectively.
Conclusions
In this small group of individuals with MDR HIV who were heavily treatment-experienced and/or faced adherence challenges, the use of IBA + LEN ± OBR was well tolerated and led to clinically significant reductions in VL and improvements in CD4+ counts.
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