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Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV

INTRODUCTION: Entry inhibitors are a relatively new class of antiretroviral therapy and are typically indicated in heavily treatment experienced individuals living with HIV. Despite this, there is no formal definition of ‘heavily treatment experienced’. Interpretation of this term generally includes...

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Autores principales: Orkin, Chloe, Cahn, Pedro, Castagna, Antonella, Emu, Brinda, Harrigan, P Richard, Kuritzkes, Daniel R., Nelson, Mark, Schapiro, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9546304/
https://www.ncbi.nlm.nih.gov/pubmed/35293094
http://dx.doi.org/10.1111/hiv.13288
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author Orkin, Chloe
Cahn, Pedro
Castagna, Antonella
Emu, Brinda
Harrigan, P Richard
Kuritzkes, Daniel R.
Nelson, Mark
Schapiro, Jonathan
author_facet Orkin, Chloe
Cahn, Pedro
Castagna, Antonella
Emu, Brinda
Harrigan, P Richard
Kuritzkes, Daniel R.
Nelson, Mark
Schapiro, Jonathan
author_sort Orkin, Chloe
collection PubMed
description INTRODUCTION: Entry inhibitors are a relatively new class of antiretroviral therapy and are typically indicated in heavily treatment experienced individuals living with HIV. Despite this, there is no formal definition of ‘heavily treatment experienced’. Interpretation of this term generally includes acknowledgement of multidrug resistance and reflects the fact that patients in need of further treatment options may have experienced multiple lines of therapy. However, it fails to recognize treatment limiting factors including contraindications, age‐associated comorbidities, and difficulty adhering to regimens. METHODS: This manuscript follows a roundtable discussion and aims to identify the unmet needs of those living with HIV who are in need of further treatment options, to broaden the definition of heavily treatment experienced and to clarify the use of newer agents, with an emphasis on the potential role of entry inhibitors, in this population. RESULTS/CONCLUSIONS: Within the entry inhibitor class, mechanisms of action differ between agents; resistance to one subclass does not confer resistance to others. Combinations of entry inhibitors should be considered in the same regimen, and if lack of response is seen to one entry inhibitor another can be tried. When selecting an entry inhibitor, physicians should account for patient preferences and needs as well as agent‐specific clinical characteristics. Absence of documented multidrug resistance should not exclude an individual from treatment with an entry inhibitor; entry inhibitors are a valuable treatment option for all individuals who are treatment limited or treatment exhausted. We should advocate for additional clinical trials that help define the role of entry inhibitors in people with exhausted/limited ART options other than drug resistance.
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spelling pubmed-95463042022-10-14 Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV Orkin, Chloe Cahn, Pedro Castagna, Antonella Emu, Brinda Harrigan, P Richard Kuritzkes, Daniel R. Nelson, Mark Schapiro, Jonathan HIV Med Review Article INTRODUCTION: Entry inhibitors are a relatively new class of antiretroviral therapy and are typically indicated in heavily treatment experienced individuals living with HIV. Despite this, there is no formal definition of ‘heavily treatment experienced’. Interpretation of this term generally includes acknowledgement of multidrug resistance and reflects the fact that patients in need of further treatment options may have experienced multiple lines of therapy. However, it fails to recognize treatment limiting factors including contraindications, age‐associated comorbidities, and difficulty adhering to regimens. METHODS: This manuscript follows a roundtable discussion and aims to identify the unmet needs of those living with HIV who are in need of further treatment options, to broaden the definition of heavily treatment experienced and to clarify the use of newer agents, with an emphasis on the potential role of entry inhibitors, in this population. RESULTS/CONCLUSIONS: Within the entry inhibitor class, mechanisms of action differ between agents; resistance to one subclass does not confer resistance to others. Combinations of entry inhibitors should be considered in the same regimen, and if lack of response is seen to one entry inhibitor another can be tried. When selecting an entry inhibitor, physicians should account for patient preferences and needs as well as agent‐specific clinical characteristics. Absence of documented multidrug resistance should not exclude an individual from treatment with an entry inhibitor; entry inhibitors are a valuable treatment option for all individuals who are treatment limited or treatment exhausted. We should advocate for additional clinical trials that help define the role of entry inhibitors in people with exhausted/limited ART options other than drug resistance. John Wiley and Sons Inc. 2022-03-16 2022-10 /pmc/articles/PMC9546304/ /pubmed/35293094 http://dx.doi.org/10.1111/hiv.13288 Text en © 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Review Article
Orkin, Chloe
Cahn, Pedro
Castagna, Antonella
Emu, Brinda
Harrigan, P Richard
Kuritzkes, Daniel R.
Nelson, Mark
Schapiro, Jonathan
Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title_full Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title_fullStr Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title_full_unstemmed Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title_short Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with HIV
title_sort opening the door on entry inhibitors in hiv: redefining the use of entry inhibitors in heavily treatment experienced and treatment‐limited individuals living with hiv
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9546304/
https://www.ncbi.nlm.nih.gov/pubmed/35293094
http://dx.doi.org/10.1111/hiv.13288
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