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Matsuda EM, da Silva Santos JH, Ahagon CM, Lopes GISL, Brigido LFDM. Transmitted antiretroviral drug resistance to Integrase Strand Transfer Inhibitors class in São Paulo metropolitan area, Brazil. AIDS Res Hum Retroviruses 2024. [PMID: 39041595 DOI: 10.1089/aid.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Objectives A newer Integrase Strand Transfer Inhibitor (INSTI) cabotegravir was recently approved for both therapy and prophylaxis and can play an essential role in the fight against AIDS. It shares similar resistance profile to dolutegravir, the cornerstone of Brazilian antiretroviral treatment (ARV), with about 600 thousand people living with HIV in Brazil currently on regimens that contain this INSTI. Health services in the São Paulo metropolitan area are responsible to a large proportion of ARV dispensation in the country. Estimating Transmitted Drug Resistance Mutation (TDRM) in the area before cabotegravir introduction may provide a useful baseline information. Methods Partial HIV-1 pol gene was sequenced (Sanger) from 192 newly diagnosed individuals from São Paulo and nearby cities (2020 to March 2023) at integrase, with 85 also at protease/reverse transcriptase regions. Retrotranscribed plasma RNA, amplified with nested PCR, was edited (Recall or Sequencher) and analyzed at Rega and Stanford db. Results Surveillance DRM (SDRM) to INSTI class was detected in three cases (1.6% CI95% 0.5%-5%), two E138K and one R263K, with 7.8% (CI95% 5%-13%) with resistance mutations (major or accessory). SDRM for NRTI, NNRTI, and PI classes were identified in 7 (8.2% CI95% 4%-16%) cases. Subtype B predominated (69%), followed by subtype C (16%), now the second most prevalent infection in this area. Among 131 patients treated for over six months, 92% were virally suppressed below 200 copies/mL, with low TCD4 counts independently associated to failure. Conclusions SDRM to INSTI class is rare in the area. Intermediate rates of transmitted resistance to other ARV classes are comparable to previous estimates. Viral suppression rates may depend on TCD4 counts, another negative impact of late diagnosis in care that deserves more attention.
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Sherman EM, Agwu AL, Ambrosioni J, Behrens GMN, Chu C, Collins LF, Jimenez HR, Koren DE, McGorman L, Nguyen NN, Nicol MR, Pandit NS, Pierre N, Scarsi KK, Spinner GF, Tseng A, Young JD, Badowski ME. Consensus recommendations for use of long-acting antiretroviral medications in the treatment and prevention of HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy, Canadian HIV and Viral Hepatitis Pharmacists Network, European AIDS Clinical Society, and Society of Infectious Diseases Pharmacists. Pharmacotherapy 2024; 44:494-538. [PMID: 39005160 DOI: 10.1002/phar.2922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 07/16/2024]
Abstract
Five long-acting (LA) antiretrovirals (ARVs) are currently available in a limited number of countries worldwide for HIV-1 prevention or treatment-cabotegravir, rilpivirine, lenacapavir, ibalizumab, and dapivirine. Implementing use of LA ARVs into routine clinical practice requires significant changes to the current framework of HIV-1 prevention, treatment, and service provision. Given the novelty, complexity, and interdisciplinary requirements needed to safely and optimally utilize LA ARVs, consensus recommendations on the use of LA ARVs will assist clinicians in optimizing use of these agents. The purpose of these recommendations is to provide guidance for the clinical use of LA ARVs for HIV-1 treatment and prevention. In addition, future areas of research are also identified and discussed.
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Affiliation(s)
- Elizabeth M Sherman
- Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, Florida, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Juan Ambrosioni
- HIV Unit and Infectious Disease Service, Hospital Clinic and Fundació de Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Georg M N Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
- Centre for Individualized Infection Medicine (CiiM), Hannover Medical School, Hannover, Germany
| | - Carolyn Chu
- University of California San Francisco, San Francisco, California, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory School of Medicine, Grady Ponce de Leon Center, Atlanta, Georgia, USA
| | - Humberto R Jimenez
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
- Comprehensive Care Center, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - David E Koren
- Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Leslie McGorman
- American Academy of HIV Medicine, Washington, District of Columbia, USA
| | - Nancy N Nguyen
- Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA
| | - Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
| | - Neha Sheth Pandit
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland, USA
| | - Natacha Pierre
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gary F Spinner
- Southwest Community Health Center, Bridgeport, Connecticut, USA
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy D Young
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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King JM, Giallonardo FD, Shaik A, McGregor S, Yeung JYK, Sivaruban T, Lee FJ, Cunningham P, Dwyer DE, Nigro SJ, Grulich AE, Kelleher AD. Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use. J Int AIDS Soc 2024; 27:e26308. [PMID: 39034597 PMCID: PMC11260875 DOI: 10.1002/jia2.26308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use. METHODS Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis. RESULTS Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008). CONCLUSIONS In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.
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Affiliation(s)
- Jonathan M King
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | | | - Ansari Shaik
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Skye McGregor
- The Kirby InstituteUniversity of New South WalesSydneyAustralia
| | - Julie Yuek Kee Yeung
- New South Wales State Reference Laboratory ‐ HIV/AIDSSt Vincent's HospitalSydneyAustralia
| | | | - Frederick J Lee
- New South Wales Health Pathology‐RPA, Royal Prince Alfred HospitalCamperdownAustralia
- Department of Clinical Immunology and AllergyRoyal Prince Alfred HospitalCamperdownAustralia
| | - Philip Cunningham
- New South Wales State Reference Laboratory ‐ HIV/AIDSSt Vincent's HospitalSydneyAustralia
| | - Dominic E Dwyer
- New South Wales Health Pathology‐ICPMRWestmead HospitalWestmeadAustralia
| | - Steven J Nigro
- Health Protection NSWNSW Ministry of HealthSydneyAustralia
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Makarova N, Singletary T, Peet MM, Mitchell J, Bachman S, Holder A, Dinh C, Lipscomb J, Agrahari V, Mendoza M, Pan Y, Heneine W, Clark MR, García-Lerma JG, Doncel GF, Smith JM. Extended Postexposure Protection Against Vaginal Simian/Human Immunodeficiency Virus Infection With Tenofovir Alafenamide Fumarate/Elvitegravir Inserts in Macaques. J Infect Dis 2024; 229:1791-1795. [PMID: 38134382 DOI: 10.1093/infdis/jiad599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Vaginal inserts that can be used on demand before or after sex may be a desirable human immunodeficiency virus (HIV) prevention option for women. We recently showed that inserts containing tenofovir alafenamide fumarate (TAF, 20 mg) and elvitegravir (EVG, 16 mg) were highly protective against repeated simian/human immunodeficiency virus (SHIV) vaginal exposures when administered to macaques 4 hours before or after virus exposure (93% and 100%, respectively). Here, we show in the same macaque model that insert application 8 hours or 24 hours after exposure maintains high efficacy (94.4% and 77.2%, respectively). These data extend the protective window by TAF/EVG inserts and inform their clinical development for on-demand prophylaxis in women.
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Affiliation(s)
- Natalia Makarova
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tyana Singletary
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Melissa Peet
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
| | - James Mitchell
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanon Bachman
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Holder
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chuong Dinh
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Lipscomb
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vivek Agrahari
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
| | - Maria Mendoza
- Quantitative Sciences Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Pan
- Quantitative Sciences Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walid Heneine
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - J Gerardo García-Lerma
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - James M Smith
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Rachman BE, Khairunisa SQ, Wungu CDK, Asmarawati TP, Rusli M, Bramantono, Arfijanto MV, Hadi U, Kameoka M, Nasronudin. Low clinical impact of HIV drug resistance mutations in oral pre-exposure prophylaxis: a systematic review and meta-analysis. AIDS Res Ther 2024; 21:37. [PMID: 38844950 PMCID: PMC11155065 DOI: 10.1186/s12981-024-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Despite the widespread use of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) transmission, scant information on HIV drug resistance mutations (DRMs) has been gathered over the past decade. This review aimed to estimate the pooled prevalence of pre-exposure prophylaxis and its two-way impact on DRM. METHODS We systematically reviewed studies on DRM in pre-exposure prophylaxis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. PubMed, Cochrane, and SAGE databases were searched for English-language primary studies published between January 2001 and December 2023. The initial search was conducted on 9 August 2021 and was updated through 31 December 2023 to ensure the inclusion of the most recent findings. The registration number for this protocol review was CRD42022356061. RESULTS A total of 26,367 participants and 562 seroconversion cases across 12 studies were included in this review. The pooled prevalence estimate for all mutations was 6.47% (95% Confidence Interval-CI 3.65-9.93), while Tenofovir Disoproxil Fumarate/Emtricitabine-associated drug resistance mutation prevalence was 1.52% (95% CI 0.23-3.60) in the pre-exposure prophylaxis arm after enrolment. A subgroup analysis, based on the study population, showed the prevalence in the heterosexual and men who have sex with men (MSM) groups was 5.53% (95% CI 2.55-9.40) and 7.47% (95% CI 3.80-12.11), respectively. Notably, there was no significant difference in the incidence of DRM between the pre-exposure prophylaxis and placebo groups (log-OR = 0.99, 95% CI -0.20 to 2.18, I2 = 0%; p = 0.10). DISCUSSION Given the constrained prevalence of DRM, the World Health Organization (WHO) advocates the extensive adoption of pre-exposure prophylaxis. Our study demonstrated no increased risk of DRM with pre-exposure prophylaxis (p > 0.05), which is consistent with these settings. These findings align with the previous meta-analysis, which reported a 3.14-fold higher risk in the pre-exposure prophylaxis group than the placebo group, although the observed difference did not reach statistical significance (p = 0.21). CONCLUSIONS Despite the low prevalence of DRM, pre-exposure prophylaxis did not significantly increase the risk of DRM compared to placebo. However, long-term observation is required to determine further disadvantages of extensive pre-exposure prophylaxis use. PROSPERO Number: CRD42022356061.
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Affiliation(s)
- Brian Eka Rachman
- Subspeciality Program in Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | | | - Citrawati Dyah Kencono Wungu
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Tri Pudy Asmarawati
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Musofa Rusli
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Bramantono
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - M Vitanata Arfijanto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Usman Hadi
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Masanori Kameoka
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-Ku, Kobe, Hyogo, 654-0142, Japan.
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Nasronudin
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Misra K, Huang JS, Udeagu CCN, Forgione L, Xia Q, Torian LV. Pre-exposure Prophylaxis Use History in People With Antiretroviral Resistance at HIV Diagnosis: Findings From New York City HIV Surveillance and Partner Services, 2015-2022. Clin Infect Dis 2024; 78:1240-1245. [PMID: 37976185 DOI: 10.1093/cid/ciad699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/03/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Drug resistance may be acquired in people starting human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) during undiagnosed infection. Population-based estimates of PrEP-related resistance are lacking. METHODS We used New York City surveillance and partner services data to measure the effect of PrEP use (tenofovir disoproxil fumarate/tenofivir alafenamide fumarate with emtricitabine) history on the baseline prevalence of M184I/V mutations in people with HIV diagnosed in 2015-2022. PrEP use was categorized as "recent" (defined as PrEP stopped ≤90 days before diagnosis), "past" (PrEP stopped >90 days before diagnosis), or "no known use." Resistance-associated mutations were determined using the Stanford algorithm. We used log binomial regression to generate the adjusted relative risk (aRR) of M184I/V by PrEP use history in people with or without acute HIV infection (AHI). RESULTS Of 4246 people with newly diagnosed HIV and a genotype obtained within ≤30 days of diagnosis, 560 (13%) had AHI; 136 (3%) reported recent and 124 (35%) past PrEP use; and 98 (2%) harbored M184I/V. In people with AHI, recent PrEP use was associated with a 6 times greater risk of M184I/V than no known use (aRR, 5.86 [95% confidence interval, 2.49-13.77]). Among people without AHI, the risk of M184I/V in recent users was 7 times that in people with no known use (aRR, 7.26 [95% confidence interval, 3.98-13.24]), and in past users, it was 4 times that in those with no known use (4.46 [2.15-9.24]). CONCLUSIONS PrEP use was strongly associated with baseline M184I/V in New York City, regardless of AHI status. Ordering a nucleic acid test when indicated after assessment of exposure, antiretroviral history, and AHI symptoms can decrease PrEP initiation in people with undetected infection.
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Affiliation(s)
- Kavita Misra
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jamie S Huang
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Chi-Chi N Udeagu
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Lisa Forgione
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Qiang Xia
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Lucia V Torian
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Mahajan PS, Smith SJ, Li M, Craigie R, Hughes SH, Zhao XZ, Burke TR. N-Substituted Bicyclic Carbamoyl Pyridones: Integrase Strand Transfer Inhibitors that Potently Inhibit Drug-Resistant HIV-1 Integrase Mutants. ACS Infect Dis 2024; 10:917-927. [PMID: 38346249 PMCID: PMC10928719 DOI: 10.1021/acsinfecdis.3c00525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
HIV-1 integrase (IN) is an important molecular target for the development of anti-AIDS drugs. A recently FDA-approved second-generation integrase strand transfer inhibitor (INSTI) cabotegravir (CAB, 2021) is being marketed for use in long-duration antiviral formulations. However, missed doses during extended therapy can potentially result in persistent low levels of CAB that could select for resistant mutant forms of IN, leading to virological failure. We report a series of N-substituted bicyclic carbamoyl pyridones (BiCAPs) that are simplified analogs of CAB. Several of these potently inhibit wild-type HIV-1 in single-round infection assays in cultured cells and retain high inhibitory potencies against a panel of viral constructs carrying resistant mutant forms of IN. Our lead compound, 7c, proved to be more potent than CAB against the therapeutically important resistant double mutants E138K/Q148K (>12-fold relative to CAB) and G140S/Q148R (>36-fold relative to CAB). A significant number of the BiCAPs also potently inhibit the drug-resistant IN mutant R263K, which has proven to be problematic for the FDA-approved second-generation INSTIs.
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Affiliation(s)
- Pankaj S Mahajan
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland 21702, United States
| | - Steven J Smith
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland 21702, United States
| | - Min Li
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Robert Craigie
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Stephen H Hughes
- HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland 21702, United States
| | - Xue Zhi Zhao
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland 21702, United States
| | - Terrence R Burke
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland 21702, United States
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Parikh UM, Penrose KJ, Heaps AL, Sethi R, Goetz BJ, Szydlo D, Chandran U, Palanee-Phillips T, Mgodi NM, Baeten JM, Mellors JW. Brief Report: HIV Drug Resistance Assessment Among Women Who Seroconverted During the MTN-025/HOPE Open-Label Extension Dapivirine Vaginal Ring Trial. J Acquir Immune Defic Syndr 2024; 95:35-41. [PMID: 37732881 PMCID: PMC11042691 DOI: 10.1097/qai.0000000000003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Clinical trials of dapivirine (DPV) vaginal ring have shown it is safe, effective, and desired by women as an HIV prevention option. The risk of drug resistance is a potential concern for DPV ring users who acquire HIV. We conducted a comprehensive resistance evaluation of plasma samples from the women who seroconverted during the Microbicide Trials Network-025/HIV Open-label Prevention Extension (HOPE) study of DPV ring. METHODS Plasma collected on the visit at which seroconversion was detected was tested by next-generation sequencing with unique molecular identifiers for non-nucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRM) present at ≥1% frequency. Bulk-cloned plasma-derived recombinant HIV was phenotyped in a TZM-bl-based assay for susceptibility to DPV and other NNRTI. HIV-1 RNA was retrospectively quantified in plasma samples collected before HIV seroconversion. RESULTS Among 38 participants who seroconverted in HOPE, 7 (18%) had NNRTI DRM detected by next-generation sequencing with unique molecular identifiers including A98G, K103N, V106M, E138A, and V179D. Six of 7 samples with NNRTI DRM had <3-fold reduction in susceptibility to DPV. Only 1 sample with K103N and V179I polymorphism had 9-fold reduction in susceptibility to DPV, but this genotype occurred in an individual who did not use DPV ring, likely indicating transmitted resistance. Detection of NNRTI resistance was not higher in individuals who remained on DPV ring >3 months after acquiring HIV infection. CONCLUSIONS NNRTI resistance among women who seroconverted during HOPE was infrequent and selection of DPV-specific mutations was not detected. DPV ring is considered a safe and effective option for HIV prevention in women.
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Affiliation(s)
| | | | | | | | | | - Daniel Szydlo
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- University of Washington, WA, USA; current affiliation Gilead Sciences, Foster City, CA, USA
| | | | - Jared M. Baeten
- University of Washington, WA, USA; current affiliation Gilead Sciences, Foster City, CA, USA
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Bekerman E, Yant SR, VanderVeen L, Hansen D, Lu B, Rowe W, Wang K, Callebaut C. Long-acting lenacapavir acts as an effective preexposure prophylaxis in a rectal SHIV challenge macaque model. J Clin Invest 2023; 133:e167818. [PMID: 37384413 PMCID: PMC10425210 DOI: 10.1172/jci167818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/28/2023] [Indexed: 07/01/2023] Open
Abstract
Long-acting antiretroviral agents for preexposure prophylaxis (PrEP) represent a promising new alternative to daily oral regimens for HIV prevention. Lenacapavir (LEN) is a first-in-class long-acting capsid inhibitor approved for the treatment of HIV-1 infection. Here, we assessed the efficacy of LEN for PrEP using a single high-dose simian-human immunodeficiency virus (SHIV) rectal challenge macaque model. In vitro, LEN showed potent antiviral activity against SHIV, as it did for HIV-1. In macaques, a single subcutaneous administration of LEN demonstrated dose proportional increases in and durability of drug plasma levels. A high-dose SHIV inoculum for the PrEP efficacy evaluation was identified via virus titration in untreated macaques. LEN-treated macaques were challenged with high-dose SHIV 7 weeks after drug administration, and the majority remained protected from infection, as confirmed by plasma PCR, cell-associated proviral DNA, and serology testing. Complete protection and superiority to the untreated group was observed among animals whose LEN plasma exposure exceeded its model-adjusted clinical efficacy target at the time of challenge. All infected animals had subprotective LEN concentrations and showed no emergent resistance. These data demonstrate effective SHIV prophylaxis in a stringent macaque model at clinically relevant LEN exposures and support the clinical evaluation of LEN for HIV PrEP in humans.
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Pike C, Bekker LG. Interrogating the promise of long-acting HIV pre-exposure prophylaxis. Trends Mol Med 2023; 29:93-98. [PMID: 36435632 DOI: 10.1016/j.molmed.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022]
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a well-established product that provides a safe and highly effective way for individuals to protect themselves against HIV infection. However, hopes of a significant reduction in HIV incidence have been disappointing because of low uptake, adherence challenges to a daily pill regimen, and consistently high discontinuation rates within 6 months of initiation. Long-acting agents have been long awaited for their potential to facilitate adherence and to offer a choice between PrEP products. As the first long-acting agents enter the market, with more poised to follow, questions around how to integrate long-acting agents into oral PrEP platforms, and what the potential advantages and pitfalls of this integration will be, now need to be considered.
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Affiliation(s)
- Carey Pike
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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