Dr Sension underlines the value of CD4 recovery from payer and clinician perspectives.
Ryan Haumschild, PharmD, MS, MBA: It’s important that we talk about CD4 recovery and how it’s important to the treatment of multidrug-resistant HIV. Dr Sension, can you talk about CD4 recovery? What are the benefits of CD4 recovery? And what are the implications of not recovering a patient’s CD4 count in a heavily treatment-experienced patient, both from the clinician and payer perspectives?
Michael Sension, MD: We’ve seen time and again, when you can achieve virological suppression, your T cells go up. How much? That remains to be seen. There are some interesting results with fostemsavir. We see an unexpected CD4 cell count rise, particularly with that medication. Whether it’s fostemsavir, ibalizumab, or lenacapavir, there was attention—in all the clinical trials that led to the approval of those 3 medications—to where people were before they started the medication and where they ended up 1, 2, 3 years later in terms of their CD4 cell counts. They specifically paid attention to people who had low T-cell counts—below 50 cells/mm3, below 200 cells/mm3—and the percentage of individuals who still had low T-cell counts 6 months, 1 year, and 2 years later. The results were promising in all 3 clinical trials, which showed that when you achieve virological suppression with the new agent, fewer individuals were in this more severe immunosuppressed state. Why is that important? Because we historically have associated low CD4 counts with more vulnerability to developing opportunistic infections and life-threatening situations due to immunosuppression. When individuals get over a certain threshold—it’s been thought to be around 200 cells/mm3—they’re out of the danger zone for severe immunosuppressive events.
Transcript edited for clarity.