A new multi-national, multi-institutional study led by senior author Dr. Guinevere Lee, Assistant Professor of Virology in Medicine in the division of Infectious Diseases in the Weill Department of Medicine, found little natural resistance to a new HIV therapy called lenacapavir in a population of patients in Uganda.
The study, published Jan. 30 in the Journal of Antimicrobial Chemotherapy, adds to growing evidence that lenacapavir may be a powerful new tool in the global anti-HIV drug arsenal. Approximately 1.5 million people are living with HIV in Uganda.
“Our data shows that only 1.6% of the individuals studied are living with HIV strains that have any known lenacapavir-associated resistance mutations,” said Dr. Lee.
Since the 1990s, HIV drug combinations targeting different steps in the virus’ life cycle have been able to reduce virus load in patients to nearly undetectable levels. But drug resistance is a growing concern as the virus has evolved ways to thwart existing therapies. Lenacapavir, however, is the first drug to disrupt the protective capsid layer surrounding HIV’s genetic material (RNA), blocking the virus’s ability to reproduce and be transmitted from person to person.
Treatment twice a year with lenacapavir has been effective in patients who have never been treated and those with HIV strains that are resistant to other drugs. Last year, clinical trials showed that lenacapavir injections were 100% effective in preventing HIV infection among women in sub-Saharan Africa, who were HIV-negative.
However, little information was available about pre-existing resistance to lenacapavir in less well-studied HIV-1 strains like subtype A1 and D, which are more common in Eastern and Southern Africa. HIV-1 subtype B strains, which predominantly affect Europe and the United States, rarely have pre-existing mutations that would cause lenacapavir drug resistance.
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