Considerations for capsid-targeting antiretrovirals in pre-exposure prophylaxis

Abstract

Antiretroviral therapy (ART) impairs viral replication in people living with HIV (PLWH) by suppressing infection or spread. However, not all treatment strategies apply to preventive applications like pre-exposure prophylaxis (PrEP) for uninfected individuals. To prevent the establishment of HIV infection, PrEP must block viral replication either before, or at the stage of integration into the host genome. A promising PrEP approach under investigation utilizes lenacapavir (LEN), which targets the HIV-1 capsid protein (CA) potently before integration. LEN, a first-in-class antiretroviral, has shown high protective efficacy in the ongoing PURPOSE trials thus far. Here, we discuss clinical investigations of LEN, theoretical suitability of preclinical CA-binding antivirals in PrEP, and other key considerations for preventing HIV-1 infection by targeting the capsid.

Keywords: acquired immunodeficiency syndrome (AIDS); antiretroviral therapy (ART); capsid protein (CA); human immunodeficiency virus (HIV); lenacapavir (LEN); pre-exposure prophylaxis (PrEP).