https://orcid.org/0000-0002-1936-5523
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Victor Hémar, Stéphane Bouchet, Emmanuel Ribeiro, Perrine Prier, Christophe Elleau, Caroline Solas, Alexandre Destere, Mojgan Hessamfar, Camille Tumiotto, Fabrice Bonnet, A case of lenacapavir use for preventing mother-to-child HIV transmission, Journal of Antimicrobial Chemotherapy, Volume 79, Issue 12, December 2024, Pages 3354–3355, https://doi.org/10.1093/jac/dkae348
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Lenacapavir, a pioneering HIV capsid inhibitor approved for HIV treatment, is used in conjunction with other antiretroviral therapies (ARTs) in multidrug-resistant HIV infections and has shown efficacy in treatment-naive patients.1,2 Administered subcutaneously every 6 months, it represents a long-acting treatment option.
In women with HIV who exhibit poor adherence to oral ART during pregnancy, the prevention of mother-to-child transmission (MTCT) poses major challenges. Injectable, long-acting treatments may be beneficial in these cases. However, data on the use of such treatments during pregnancy are limited, as pregnancy is typically an exclusion criterion in development trials, despite the absence of evidence for teratogenic effects in animal models.2
We present what we believe to be the first reported case of lenacapavir use in preventing MTCT in a 31-year-old woman. Diagnosed with HIV-1 in 2012 in Côte d’Ivoire at age 21, she has not developed any acquired immunodeficiency syndrome-related illnesses despite a nadir CD4 count of 1/mm3. She experienced poor adherence to various ART combinations, leading to multiple virological failures and limited immune reconstitution (maximum CD4 count of 329/mm3 in 2020). During her first pregnancy in 2020 in France, MTCT was prevented despite high viral replication. She underwent a preventive caesarean section, received peripartum ZDV infusion and her newborn was given prophylactic ART. Due to ongoing non-adherence to oral ART, she commenced an injectable long-acting regimen with cabotegravir + RPV in November 2022. Despite no initial resistance mutations to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors, she developed virological failure due to rapid acquisition of resistance mutations. A new oral ART regimen of TDF + FTC + DRV/RTV was initiated in February 2023.
