Therapeutic efficacy of albuvirtide-based antiretroviral therapy in people living with HIV who have low-level viremia and non-AIDS-defining malignancies: two case reports

Abstract

Background: People living with HIV (PLWH) who experience low-level viremia (LLV) face unique challenges in disease management, particularly when diagnosed with concurrent malignancies. Albuvirtide (ABT), a long-acting HIV fusion inhibitor approved in China, has shown promise in clinical trials for treatment-experienced individuals. However, its efficacy in managing LLV in the context of concurrent malignancies remains under-explored.

Case presentation: We report two cases of PLWH with LLV who developed non-AIDS-defining cancers(NADCs). The first individual developed lung squamous cell carcinoma, and the second was diagnosed with breast cancer. Both patients received ABT as part of their optimized antiretroviral therapy (ART) regimen during their cancer treatment course. After treatment optimization, both cases achieved viral suppression (HIV-1 RNA < 50 copies/mL) with improvements in CD4 + T cell counts. Both patients received appropriate cancer treatments according to clinical practice guidelines. The patient diagnosed with lung cancer required an adjustment to his PD-1 inhibitor monotherapy due to intolerance to chemotherapy, whereas the breast cancer patient successfully completed her planned multimodal treatment regimen.

Conclusions: These cases suggest potential benefits of ABT-containing ART regimens in PLWH who have LLV and concurrent NADCs. While two cases cannot establish definitive conclusions, they highlight the need for larger studies investigating the role of ABT in this complex clinical scenario.

Keywords: Albuvirtide; Antiretroviral therapy; Case report; HIV; Low-level viremia; Non-AIDS-defining cancers.

Fig. 1

Serial chest CT imaging studies of Case 1 A: Contrast-enhanced chest CT (November 11, 2023) demonstrating a large left hilar mass (89 mm × 66 mm) with lobulation, spiculation, pleural indentation, and air bronchogram signs. Multiple nodular densities are present in both lungs with ground-glass opacities in the lower lobes. Enlarged bilateral hilar and mediastinal lymph nodes are visible (largest measuring 35 mm in long diameter). B: Follow-up chest CT (January 02, 2024) showing the evolution of the left hilar mass with associated changes in the surrounding lung parenchyma. C: Case 1 (Lung Cancer Patient). The graph demonstrates the temporal relationships between HIV diagnosis, initial antiretroviral therapy (TLE regimen), lung cancer diagnosis, cancer treatment initiation, ABT introduction, and subsequent modification to PD-1 inhibitor monotherapy. Note the rapid decline in viral load following ABT initiation despite severe immunosuppression related to cancer and its treatment. TLE: tenofovir disoproxil fumarate, lamivudine, and efavirenz; ABT: albuvirtide

Fig. 2

Breast imaging of Case 2 A: Contrast-enhanced breast MRI (November 23, 2023) demonstrating a large heterogeneous mass in the upper outer quadrant of the right breast (axial view). B: Contrast-enhanced breast MRI (November 23, 2023) showing the same lesion in sagittal view with characteristic malignant features including irregular margins and heterogeneous enhancement. B: Case 2 (Breast Cancer Patient). The timeline illustrates the relationships between HIV diagnosis, initial antiretroviral therapy, breast cancer diagnosis, ABT introduction, surgical intervention (mastectomy), and chemotherapy initiation. The gradual decline in viral load and steady improvement in CD4 + T cell count occurred despite concurrent cancer therapy. Vertical dashed lines indicate key clinical interventions. TLE: tenofovir disoproxil fumarate, lamivudine, and efavirenz; ABT: albuvirtide