Authors: Blake Max (Cook County Health, IL, USA)
Take a look behind the scenes of a recent Future Virology article, entitled ‘Update on HIV integrase inhibitors for the treatment of HIV’, as we ask the authors about these drugs for HIV treatment and the future of this field.
What inspired you to write this piece?
Ellen Colvin contacted me about writing the article, I had written a previous manuscript on dolutegravir (another INSTI) in 2017 and as an HIV clinical pharmacist for the past 20 years this is a class of drugs I’m very familiar with.
How have HIV-1 integrase strand transfer inhibitors (INSTIs) challenged more traditional treatments?
This class of antiretrovirals have shown to be clinically superior to other ‘traditional’ antiretrovirals in terms of viral load reduction. This class is also well tolerated, limited drug interactions with few side effects and co-formulated as a single tablet (with other agents) – all favorable characteristics over some of the other older HIV treatments
Which INSTIs are the most effective and why?
Dolutegravir and bictegravir are the most effective because they are once daily, well tolerated and have a high barrier to resistance compared with other drugs in this class.
What unknowns are there for using INSTIs?
Unknowns are some recent data about the possibility of neural tube defects at the time of conception and unintentional weight gain, and of course long-term side effects since this is a disease that requires lifetime treatment.
What are your predictions for next 10–15 years in this field? What do you hope to see?
The goal in the next 10–15 years is ‘getting to zero’; this means no new infections, which hopefully can be achieved by getting the majority of those infected diagnosed and on therapy immediately and to keep patients in care and on therapy. If this challenge can be met and patients understand that undetectable viral load means unable to transmit the virus then no new infections can be achieved.
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