MONDAY, July 29, 2024 (HealthDay News) — In a research letter published online July 24 in the New England Journal of Medicine, the authors describe long-acting early viral inhibition (LEVI) among patients with acute HIV infection in the context of long-acting injectable cabotegravir (CAB-LA) preexposure prophylaxis (PrEP). The research was published to coincide with the 25th International AIDS Conference, held from July 22 to 26 in Munich.
Noting that in the HIV Prevention Trials Network (HPTN) 083 and 084 trials, altered presentation of acute HIV infection in the context of CAB-LA PrEP, LEVI was observed, Raphael J. Landovitz, M.D., from the University of California in Los Angeles, and colleagues examined presentations of HIV infection involving LEVI and classic HIV infection.
The authors note that cases involving LEVI were characterized by low or undetectable HIV viral load and reduced or delayed antibody production, and were usually clinically silent. HIV antigens, antibodies, RNA, and DNA levels were often near the level of detection of available assays, which may revert from reactive, indeterminate, or positive to nonreactive or negative, challenging confirmation of HIV. Forty-one HIV infections were identified among 3,446 participants who had been randomized to receive CAB-LA in trials HPTN 083 and 084; detection of an infection was delayed in 17 (41 percent) when an HIV rapid test and a HIV antigen and antibody test were used for screening.
“When interpreting HIV test results in persons who are receiving CAB-LA PrEP, providers should recognize that a prolonged period of observation with frequent retesting may be needed before infection can be confirmed or ruled out,” the authors write.
Several authors disclosed ties to biopharmaceutical companies, including ViiV Healthcare and Gilead Sciences, which donated trial medications and matching placebos. ViiV Healthcare provided additional funding.
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