New HIV Treatment Development

Researchers at Queen Mary University of London have led the clinical development of the first non-integrase strand-transfer inhibitor (INSTI) single tablet treatment for HIV.

The results of the phase 3 trial, published in The Lancet, indicate that the once-daily, single tablet combination of doravirine with islatravir is an effective and safe treatment for HIV.

Context of HIV Treatment

Current recommended HIV treatment regimens primarily include integrase strand-transfer inhibitors (INSTIs). These drugs are effective, have a high barrier to resistance, are well-tolerated, and have low drug-drug interaction liability, making them first-line treatments globally, including in low-income regions.

However, public health surveillance data from WHO regions shows evidence of emerging resistance to INSTIs, prompting a requirement for non-integrase HIV treatments.

Key Study Findings

The study, led by Professor Chloe Orkin, Director of the SHARE Collaborative at Queen Mary University of London, demonstrated that the doravirine plus islatravir combination has similar efficacy and safety profiles to integrase inhibitors.

The trial notably included a higher-than-usual number of women, older individuals, and racially minoritized adults, groups often under-represented in HIV treatment trials. Professor Orkin also previously led the development of the first long-acting injectable HIV treatment, Cabotegravir and Rilipivirine.

Expert Perspective

Professor Orkin stated that this development is significant for HIV treatments, as INSTI-resistance could impact the long-term health of people living with HIV, necessitating novel treatments like doravirine/islatravir.

She also noted that islatravir possesses long-acting potential and is being evaluated as a weekly tablet for HIV at Barts Health NHS Trust and internationally, marking its daily pill form as a step toward more long-acting formulations.