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Baseline and week 48 resistance analysis in participants receiving bictegravir + lenacapavir in the phase 2 ARTISTRY-1 study
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AIDS Aug 2026
Download the PDF here
Download the PDF here
Background:
ARTISTRY-1 is an operationally seamless Phase 2/3 study evaluating the safety and efficacy of once-daily oral lenacapavir (LEN) + bictegravir (BIC) in virologically suppressed participants without known integrase strand-transfer inhibitor (INSTI) resistance, compared to a complex multi-tablet regimen.
Methods:
Baseline HIV-1 resistance-associated mutations (RAMs) were assessed via historical genotypic reports (HGR) and proviral DNA genotyping (GenoSure Archive, Monogram Biosciences). The impact of baseline RAMs on Week 48 efficacy in the Phase 2 part of the study was evaluated. Post-baseline genotypic and phenotypic resistance was assessed in participants with confirmed virologic rebound (HIV-1 RNA ≥50 copies/ml; analyzed if ≥200 copies/ml).
Results:
Baseline HIV-1 genotypic data from HGR and/or proviral DNA analyses were available for 98% (125/128) of participants. RAMs for nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) were found in 81%, 65%, and 46% of participants, respectively; 11% had primary INSTI RAMs by proviral DNA genotyping. Baseline RAMs had no impact on Week 48 efficacy. One participant with baseline resistance to NRTIs, NNRTIs, and PIs, and detectable baseline viral load met the criteria for resistance testing. A novel capsid polymorphism (N74T) emerged in this individual, with no impact on LEN susceptibility.
Primary INSTI RAMs were identified in 11% of participants at baseline by proviral DNA analysis only, as the presence of INSTI resistance in HGR was exclusionary and included T66T/A/I/K (n = 2, 2.1%), E92E/G/Q/V (n = 1, 1.1%), G140G/R (n = 1, 1.1%), S147S/G (n = 1, 1.1%), Q148Q/H/K/R (n = 4, 4.3%), N155N/H/S (n = 4, 4.3%), and R263R/K (n = 1, 1.1%) (Table S1, Supplementary Digital Content, https://links.lww.com/QAD/D835).
Conclusions:
Despite high frequencies of baseline resistance, substantial rates of viral suppression were maintained through Week 48 and no on-treatment resistance to study drugs was detected. These findings support the development of once-daily BIC+LEN STR to improve and optimize treatment options in individuals on complex ART.
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