Trogarzo is the least appreciated THTX’s asset “Resistance typically develops as a result of selective drug pressure during treatment with a particular regimen.3 It is associated with a decreased susceptibility to ARTs and an increase in mortality.1 Although up to 76% patients develop resistance, estimates vary considerably based on viral load, prior ART exposure, treatment duration and patient adherence.
Another major barrier to effective treatment is the side effect (SE) profile of ARTs. SEs include lipodystrophy (disproportionate changes in fat distribution), cardiovascular events, peripheral neuropathy…”
Tesamorelin is approved for PLWH, has been and is investigated for cardiovascular risks and peripheral nerve injuries!
“Novel agents for MDR HIV
Novel therapies and agents in development offer promise for patients who have limited treatment options to effectively manage their MDR HIV infection.
FDA-approved options for MDR HIV infection
Ibalizumab
Ibalizumab is a humanized IgG4 monoclonal antibody that binds to CD4 that was approved for intravenous administration by the FDA in 2018.24-26 Ibalizumab, in combination with other antiretrovirals, is indicated for the treatment of HIV-1 infection in heavily treatment-experienced adults with MDR HIV-1 infection for whom their current antiretroviral regimen fails….
Common SEs associated with ibalizumab were diarrhea, nausea, fatigue, pyrexia, rash and dizziness, and most (87%) were mild or moderate.25 Grade 3 or 4 SEs occurred in 11 patients (28%), and four (10%) had AIDS-defining SEs. Nine patients (23%) had serious SEs. Finally, seven patients had virologic failure and three patients experienced viral rebound.
Fostemsavir
Fostemsavir, an oral prodrug of an HIV-1 attachment inhibitor,27 was approved for use by the FDA in 2020.28 Fostemsavir is indicated in combination with other antiretrovirals for the treatment of HIV-1 infection in heavily treatment-experienced adults with MDR HIV-1 infection for whom their current antiretroviral regimen fails due to resistance, intolerance or safety considerations.
Almost all patients (92%) reported SEs and most serious SEs were due to progressive disease.27 A total of 77 (21%) patients had grade 2 to 4 drug-related SEs, which included nausea (4%) and diarrhea (3%). Virologic failure occurred in 18% of patients in the randomized cohort and 46% in the nonrandomized cohort.”
It seems in terms of effectiveness and side effects Trogarzo is the better of two!
“Although these newer agents are associated with high costs, the development of MDR HIV is multifactorial, and poor patient adherence to ART plays a key role.38 Long-acting ARTs, administered through subcutaneous or intravenous routes, may offer greater adherence and convenience, which could improve patient outcomes.38
Conclusions
While the introduction of combined ARTs helped reduce the occurrence of resistant HIV, there are still people living with MDR HIV infection for whom existing therapies are inadequate. Therefore, it is necessary to develop novel therapies for this group of patients. In the past few years, two novel agents, ibalizumab and fostemsavir, have been approved by the FDA and a third one, lenacapavir, is under review. Additionally, other agents are in development and offer promise.”
https://www.managedhealthcareexecutive.com/view/the-challenge-of-multidrug-resistant-hiv-evolution-testing-and-promising-treatment-options