Lenacapavir

How it works

It binds the HIV-1 capsid protein and interferes with multiple steps of the viral lifecycle, including capsid-mediated nuclear uptake, virus assembly and release, and capsid core formation.

Prescribing in practice

• Because subcutaneous lenacapavir forms a long-acting depot that persists for many months, it must be combined with a fully active regimen and residual drug levels considered if stopped, to avoid resistance.
• Injection-site reactions, including nodules and swelling, are common with the subcutaneous depot.
• It is a moderate CYP3A inhibitor and interacts with strong CYP3A and P-glycoprotein inducers, which should be avoided.

Monitoring

Monitor HIV viral load and treatment response, and review injection sites and concomitant medicines for interactions.

Counselling the patient

• Keep all scheduled injection appointments, as missed doses can let the virus become resistant.
• A firm lump or swelling where the injection is given is common and usually settles.
• The medicine stays in your body for many months, so tell any clinician you have received it.

Evidence & guidelines

Efficacy in heavily treatment-experienced patients with multidrug-resistant HIV-1 was shown in the CAPELLA trial.