Optimising drug-resistant human immunodeficiency virus treatment in India: The potential of entry inhibitors

Human immunodeficiency virus (HIV) entry inhibitors are potential treatments for drug-resistant HIV in India. HIV drug resistance is increasing globally and in India, necessitating new treatment options. The current management strategies for resistant HIV cases have limitations, including emerging resistance to dolutegravir. Four food and drug administration (FDA)-approved entry inhibitors are examined: Enfuvirtide, maraviroc, ibalizumab and fostemsavir. Their mechanisms of action, dosing regimens and efficacy from key clinical trials are presented. These inhibitors are effective against resistant strains and have a high genetic barrier to resistance. However, they also have limitations, such as parenteral administration requirements and high costs. Data suggest that despite higher initial costs, entry inhibitors can be cost-effective by reducing hospitalisations and long-term healthcare costs for managing drug-resistant HIV. HIV entry inhibitors have the potential to address drug resistance challenges and improve HIV treatment outcomes in India. Recommendations for India include considering the inclusion of enfuvirtide and maraviroc in national treatment guidelines for heavily treatment-experienced patients with resistant HIV.