The introduction of triple-drug therapies brought hopes that drug resistance in HIV would be vanquished. It was hypothesized that because each of these 3 drugs individually decreased the R0 (i.e., basic reproductive number) below one, any HIV mutations conferring resistance against one class of HIV agent could be offset by the other two classes of drugs. Nevertheless, HIV defied expectations and evolved to develop resistance against triple therapy for unknown reasons.

In July 2020, the FDA approved fostemsavir (Rukobia) for the treatment of heavily-treatment-experienced patients with multidrug resistance who cannot be treated with other agents due to resistance, safety concerns, contraindications, or intolerability. In this select patient population, fostemsavir can be integrated into treatment plans as an effective core component.

Fostemsavir belongs to a novel class of antiretroviral drugs and exhibits no observed cross-resistance. The active moiety temsavir attaches to the viral envelope protein gp120 located on the surface of HIV-1 virions; this prevents viral entry and leaves CD4+ T-cells undisturbed. In a phase 3 trial, patients who were experiencing treatment failure with viral loads ≥400 copies/mL or had 2 or fewer antiretroviral classes remaining at baseline were studied. By week 96, 60% of 272 randomized patients receiving fostemsavir plus optimized background therapy (OBT) attained virologic suppression. Moreover, all patients—even those who were most severely immunocompromised at baseline—experienced robust CD4+ T-cell recovery.

 What has your experience been with fostemsavir in heavily-treatment-experienced patients with multidrug resistance? How should this therapy fit into current treatment plans?

The introduction of triple-drug therapies brought hopes that drug resistance in HIV would be vanquished. It was hypothesized that because each of these 3 drugs individually decreased the R0 (i.e., basic reproductive number) below one, any HIV mutations conferring resistance against one class of HIV agent could be offset by the other two classes of drugs. Nevertheless, HIV defied expectations and evolved to develop resistance against triple therapy for unknown reasons.



In July 2020, the FDA approved fostemsavir (Rukobia) for the treatment of heavily-treatment-experienced patients with multidrug resistance who cannot be treated with other agents due to resistance, safety concerns, contraindications, or intolerability. In this select patient population, fostemsavir can be integrated into treatment plans as an effective core component.



Fostemsavir belongs to a novel class of antiretroviral drugs and exhibits no observed cross-resistance. The active moiety temsavir attaches to the viral envelope protein gp120 located on the surface of HIV-1 virions; this prevents viral entry and leaves CD4+ T-cells undisturbed. In a phase 3 trial, patients who were experiencing treatment failure with viral loads ≥400 copies/mL or had 2 or fewer antiretroviral classes remaining at baseline were studied. By week 96, 60% of 272 randomized patients receiving fostemsavir plus optimized background therapy (OBT) attained virologic suppression. Moreover, all patients—even those who were most severely immunocompromised at baseline—experienced robust CD4+ T-cell recovery.



 What has your experience been with fostemsavir in heavily-treatment-experienced patients with multidrug resistance? How should this therapy fit into current treatment plans?