How to formulate an effective ART regimen acceptable to 56-year-old man, with unsuppressed HIV, 20+ yr. ART history, extensive drug resistance, and adherence challenges? Listen as Eileen and Chris interpret resistance testing results, discuss barriers to treatment and adherence for this patient, and evaluate the possibility of using one of the novel agents—fostemsavir, ibalizumab, and lenacapavir. What would you do?

References and Resources Cited:

• Emu B, Fessel J, Schrader S, et al. Phase 3 Study of Ibalizumab for Multidrug-Resistant HIV-1. N Engl J Med. 2018;379(7):645-654. PMID: 3010589
• Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in Adults with Multidrug-Resistant HIV-1 Infection. N Engl J Med. 2020;382(13):1232-1243. PMID: 32212519
• Segal-Maurer S, DeJesus E, Stellbrink HJ, et al. Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection. N Engl J Med. 2022;386(19):1793-1803. PMID: 35544387
• HIVAssist.org: A free, interactive, educational tool to inform clinical decision making for ARV selection.
• Stanford University HIV Drug Resistance Database: A curated public database to represent, store and analyze HIV drug resistance data.
•  FDA: Rukobia (fostemsavir) Highlights of Prescribing Information
• FDA: Sunlenca (lenacapavir) Highlights of Prescribing Information
• FDA: Trogarzo (ibalizumab) Highlights of Prescribing Information

Related NYSDOH AIDS Institute Clinical Guidelines:

• Second-Line ART After Treatment Failure or for Regimen Simplification
• HIV Resistance Assays
• Primary Care for Adults With HIV