Prezista (darunavir) / J&J - LARVOL DELTA

Therapeutic drug monitoring uncovering incorrect antiretroviral drug intake in a patient with swallowing difficulties. (PubMed, IDCases) - "Treatment with darunavir/cobicistat/emtricitabine/tenofovir alafenamide (Symtuza®) was initiated, with the patient choosing to chew the tablet before swallowing because of her swallowing difficulties. After correction of the drug intake conditions, darunavir exposure increased to therapeutic levels. This case highlights the clinical value of therapeutic drug monitoring in identifying medication intake errors and optimising antiretroviral therapy in patients with swallowing difficulties."

Journal • Human Immunodeficiency Virus • Infectious Disease

Late-stage Diversification of HIV-1 Protease Inhibitor via SuFEx Click Chemistry. (PubMed, Synthesis (Stuttg)) - "HIV-1 protease (HIV-PR) remains a central target, and although darunavir (DRV) exhibits exceptional resilience, resistance evolution necessitates continued innovation...Sulfur(VI) fluoride exchange (SuFEx) chemistry was employed as a robust late-stage diversification strategy, enabling efficient coupling and rapid library generation. This approach highlights the potential to access structurally diverse HIV-1 protease inhibitors, laying the groundwork for the development of next-generation therapeutics."

Journal • Human Immunodeficiency Virus • Infectious Disease

Older people living with HIV: a population with high prevalence and severity of metabolic dysfunction-associated steatotic liver disease ‒ A cross-sectional study. (PubMed, Braz J Infect Dis) - "MASLD was highly prevalent among older PLWH, with a substantial proportion presenting moderate-to-severe steatosis and significant fibrosis. Metabolic and adiposity-related factors were independently associated with hepatic steatosis, while lipodystrophy and higher ALT levels were associated with greater steatosis severity."

Journal • Observational data • Fibrosis • Hepatology • Immunology • Infectious Disease • Lipodystrophy • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • CD4

Activated Sludge in the Bioremediation of Water Containing SARS-CoV-2 Antivirals. (PubMed, J Xenobiot) - "This study evaluates the removal percentages, kinetic mechanisms, and toxicity profiles of six SASs, daclatasvir (DCV), darunavir (DRV), favipiravir (FAV), lopinavir (LOP), remdesivir (REM), and ritonavir (RIT), using activated sludge. Perturbation analysis showed that all tested factors have a distinct influence on process performance. These established kinetic trends should support further investigations into advanced biological wastewater treatment methods and precise ecotoxicity profiling of emerging biotransformation products."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Fluorinated HIV-1 protease inhibitors containing chiral hydroxyethylbenzene and indanol as P2′ ligands with potent activity against drug-resistant variants | Poster Board #1425 (ACS-Fall 2026) - "A series of darunavir analogs were designed by incorporating chiral 4-(1-hydroxyethyl)benzene and 1-indanol moieties as P2′ ligands, in combination with P1 fluorination...To maintain polar interactions in the S2′ subsite of HIV-1 protease, the orientation of the (R)-indanol moiety was flipped relative to the (S)-1-indanol moiety. The SAR data and structural analysis offer insights for further optimization to improve potency against drug-resistant HIV-1 variants."

Human Immunodeficiency Virus • Infectious Disease

Are distal HIV protease substitutions mere spectators or do they directly contribute to inhibitor resistance? (ACS-Fall 2026) - "PRp51 has high resistance (>1,432 fold) against a protease inhibitor darunavir (DRV), but not against another protease inhibitor GRL142...The present data suggest that proximal and distal substitutions work in concert, and together directly impact the binding cavity volume, binding interactions, and contribute to the loss of PI-binding that causes drug resistance. The study suggests important insights into the design of a newer generation of inhibitors that can maintain activity against drug-resistant HIV."

Human Immunodeficiency Virus • Infectious Disease

Pharmacokinetic modeling to support WHO-weight band dosing of a new pediatric darunavir/ritonavir (120/20 mg) fixed-dose combination tablet for children at least 3 years old and weighing 10 to less than 35 kg. (PubMed, J Acquir Immune Defic Syndr) - "Model-based dosing supports once- and twice-daily of the pediatric DRV/r 120mg/20mg FDC tablet across WHO-weight bands."

Journal • PK/PD data • Human Immunodeficiency Virus • Infectious Disease • Pediatrics

Machine-learning-guided library screening and drug resistance profiling of HIV-1 protease inhibitors. (PubMed, J Mol Graph Model) - "This workflow prioritizes three computationally predicted mutation-tolerant candidates, of which ZINC000408994641 shows the most consistent in silico profile, with favorable or comparable predicted binding energetics and efficiency metrics relative to darunavir and tipranavir, and limited predicted loss of affinity across clinically relevant protease variants. These results demonstrate that coupling ML-based large-scale prioritization with structure-based and dynamical validation can prospectively enrich for resistance-robust HIV-1 protease inhibitors and provide a generalizable framework for anticipating drug resistance in rapidly evolving viral targets."

Journal • Human Immunodeficiency Virus • Infectious Disease

Contemporary Single and Multi-Tablet HIV Treatment Regimens Are Associated With Similar Levels of Viral Suppression. (PubMed, Open Forum Infect Dis) - "In multivariate analysis, lower levels of viral suppression were significantly associated with female sex at birth, younger age, being unstably housed, and use of darunavir-containing MTRs, but not other ART regimens. Viral suppression was lower among persons treated with 2025 US guideline recommended 1st-line MTRs (dolutegravir [DTG] + emtricitabine [FTC]/tenofovir alafenamide [TAF], DTG + FTC/tenofovir disoproxil fumarate [TDF], DTG + lamivudine [3TC]) than bictegravir (BIC)/FTC/TAF, however, this difference was not significant (88.9% vs 91.6%, RRadj = 0.98, 95% CI 0.94-1.01). Viral suppression did not significantly vary between persons on BIC/FTC/TAF and 1st-line MTRs among unstably housed persons (78.8% vs 78.2%, RR = 1.00, 95% CI 0.84-1.19). Differences in viral suppression between contemporary STRs and 1st-line MTRs, if any, are likely small. Factors other than drug efficacy-including cost-should inform decisions to use STRs versus 1st-line MTRs."

Clinical • Journal • Human Immunodeficiency Virus • Infectious Disease

Conformational asymmetry of human immunodeficiency virus-1 protease flaps increases along the darunavir drug resistance pathway. (PubMed, Protein Sci) - "Solid-state 19F magic angle spinning (MAS) NMR spectra of wt-PR and 10Mut also exhibited two W42 resonances in DRV-bound crystalline forms. These observations indicate that drug-resistance mutations increase the asymmetry between the two flaps in the PR-inhibitor interaction in the inhibitor-bound forms."

Journal • Human Immunodeficiency Virus • Infectious Disease

Autoimmune hemolytic anemia in people living with HIV: distinct clinical presentations, triggers, and outcomes in three adult cases (AIDS 2026) - " Case 1: 38-year-old with advanced immunosuppression receiving tenofovir, lamivudine, and dolutegravir (TDF/3TC/DTG), presented with acute neurological symptoms, fever, dark urine, and profound anemia...Treatment with high-dose prednisone, rituximab, and paclitaxel resulted in complete clinical and hematologic remission without transfusion. Case 2: 40-year-old with poor ART adherence on TDF/3TC and atazanavir/ritonavir developed transfusion-refractory wAIHA following a self-limited human metapneumovirus pulmonary infection. He exhibited persistent hemolysis with IgG DAT positivity and improved progressively after methylprednisolone pulse therapy, intravenous immunoglobulin, and ART optimization with darunavir-based therapy... These cases illustrate the heterogeneity, severity, and prognostic variability of AIHA in PLWH. Viral infections and lymphoproliferative disorders emerged as relevant triggers. Early recognition and subtype-specific management are essential, as..."

Clinical • Anemia • Autoimmune Hemolytic Anemia • Complement-mediated Rare Disorders • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Pulmonary Disease • Respiratory Diseases • Septic Shock

Darunavir and Fosamprenavir Inhibit Zika Virus Replication via Dual Targeting of the Envelope Protein and NS2B-NS3 Protease. (PubMed, J Med Virol) - "In a suckling mouse model, both DRV and FPV reduced viral loads in brain tissues in a dose-dependent manner, with DRV showing superior efficacy at lower doses. Collectively, these findings demonstrate that DRV and FPV exert potent anti-ZIKV activity through dual targeting of viral entry and protease function, highlighting their potential as repurposed therapeutics for ZIKV infection."

Journal • Human Immunodeficiency Virus • Infectious Disease

Computational drug discovery of novel HIV-1 protease inhibitors using generative AI, virtual screening, and molecular dynamics simulations (AIDS 2026) - "MD simulations revealed stable protein–ligand complexes, with sustained interactions within the HIV-1 protease active site; notably, Compound 323 demonstrated the highest dynamic stability compared with the reference ligand (Darunavir). This study highlights the effectiveness of integrating generative AI with virtual screening and MD simulations for the discovery of new HIV-1 PR inhibitors. The identified lead compounds, especially Compound 323, exhibit a promising binding affinity, stability, and drug-like characteristics, warranting further experimental validation as potential therapeutic candidates against drug-resistant HIV-1 variants."

Human Immunodeficiency Virus • Infectious Disease

Virologic outcomes of Ritonavir-boosted Darunavir-based ART in treatment-experienced youth with HIV in Malawi (AIDS 2026) - "Genotype-guided transition to DRV/r-based ART achieved high viral suppression rates among treatment-experienced patients with perinatally acquired HIV. Most clients suppressed soon after switching, with the exception of the youngest child, who had persistent high viral loads after the switch, likely due to drug administration challenges and limited pediatric formulations. These findings show that genotype-informed use of DRV/r can be effective, though child-friendly formulations and expanded resistance testing are needed."

Human Immunodeficiency Virus • Infectious Disease

A Study to Provide Continued Access to Study Drug to Children and Adolescents Who Have Completed Clinical Studies Involving Gilead HIV Treatments (clinicaltrialsregister.eu) - P4 | N=290 | Sponsor: Gilead Sciences, Inc.

New P4 trial • Human Immunodeficiency Virus • Infectious Disease • Pediatrics

Virologic failure on dolutegravir‑based second‑line ART: real‑world outcomes from Harare, Zimbabwe (AIDS 2026) - " We conducted a retrospective cohort study of PLWH who switched from protease-inhibitor (PI)-based ART (atazanavir/r or lopinavir/r) to DTG-based ART between January 2019 and June 2025...We describe the outcomes among participants who continued DTG after adherence support and those who were switched to darunavir (DRV)-containing third-line therapy... Most participants achieved re-suppression on DTG-based ART following adherence support, without switching to third-line therapy. Fewer than half of those with genotypic results showed evidence of emergent DTG resistance. These findings highlight the continued importance of adherence counselling in managing PLWH with a history of treatment failure."

Clinical • Real-world • Real-world evidence • Human Immunodeficiency Virus • Infectious Disease

Affordability of antiretrovirals: have productive development partnerships for local production and technology transfer contributed to the sustainability of Brazil’s universal access policy? (AIDS 2026) - " Ten active PDPs (4 in Phase III; 6 in Phase IV) for 7 ARVs (atazanavir, darunavir, dolutegravir, emtricitabine/lamivudine, ritonavir, tenofovir, and tenofovir/lamivudine) were identified, involving 12 laboratories (5 public, 5 private national and 2 international). While local production is vital for health sovereignty, PDPs did not consistently contribute to ARV affordability from 2015-2025. Competition appears to remain a key driver for price reduction. Recent policy updates might correct existing distortions to ensure greater affordability gains."

Human Immunodeficiency Virus • Infectious Disease

Resuppression and resistance after confirmed virologic failure among women on CAB+RPV LA in the OPERA Cohort (AIDS 2026) - "Summary of resistance in the 7 women who experienced CVF on CAB+RPV LA Woman who experienced CVF on CAB+RPV LA VL at Start (c/mL ) BMI at Start (kg/m 2 ) Months to CVF M onths to Resuppression a Regimen when Resuppressed a Summary of Resistance #1 20 25.1 1.6 5.5 CAB+RPV LA Multiple polymorphisms before and during CAB+RPV LA; no resistance to CAB or RPV at CVF; resuppressed on CAB+RPV LA through study end #2 < 20 49.6 7.4 2.9 DRV/c/FTC/TAF Partial resistance to NNRTIs other than RPV before CAB+RPV LA; resistance to CAB and RPV at CVF #3 30 36.6 9.2 5.7 BIC/FTC/TAF GenoSure Archive prior to CAB+RPV LA had insufficient sample; no further testing done; resuppressed through study end on B/F/TAF #4 35,500 18.3 9.1 N/A b N/A b Multiple polymorphisms before CAB+RPV LA; resistance to CAB and RPV after CVF #5 < 20 27.8 15.3 15.6 DRV/c/FTC/TAF + LEN No resistance tests prior to CAB+RPV LA; multiple polymorphisms during CAB+RPV LA; LLV until 3 rd regimen post CVF #6 < 20..."

Clinical • Human Immunodeficiency Virus • Infectious Disease

Antiretroviral treatment trajectories and post-listing outcomes in people living with HIV or AIDS listed for kidney or liver transplantation: a national cohort study in Brazil (AIDS 2026) - "Longer cumulative exposure to multiple antiretrovirals—including lamivudine, zidovudine, efavirenz, darunavir, dolutegravir, lopinavir, nevirapine, ritonavir, and tenofovir disoproxil fumarate—was consistently associated with lower post-listing mortality (Spearman ? In this nationwide study, longer cumulative exposure to widely used antiretrovirals was associated with lower mortality after listing, even for drugs traditionally described as hepatotoxic or nephrotoxic. This suggests, in this context, cumulative ART exposure primarily reflects sustained engagement in care, rather than a direct pharmacological toxicity effect on mortality. This first national linkage of transplant and HIV information systems provides evidence to inform the integration of HIV care and transplant services, and supports future evaluations of equity and outcomes among aging populations living with HIV."

Human Immunodeficiency Virus • Infectious Disease • Solid Organ Transplantation • Transplantation

High virological failure in people with major DTG-associated DRTs continuing on standard dose DTG: the Ndovu RCT (AIDS 2026) - "Participants on DTG for at least 6 months, with persistent viraemia of = 200 copies/ml despite enhanced adherence counselling, and = one major DTG-associated drug resistance mutations (DRMs) are randomised 1:1 to continue once daily DTG or to switch to ritonavir boosted darunavir (DRV/r), in combination with tenofovir (abacavir for children <30kg) and lamivudine...Country Kenya Lesotho Mozambique Tanzania 38 (100%) 0 0 0 33 (97.1%) 1 (2.9%) 0 0 Sex Female Male 25(65.8%) 13 (34.2%) 18 (52.9%) 16 (47.1%) Age (years) Median (IQR) =15 years 3-14 years 30.5 (18.0, 42.0) 32 (84.2%) 6 (15.8%) 37.5 (20.0, 44.0) 28 (82.4%) 6 (17.6%) Enrollment Viral Load Category 400-999 1,000-9,999 10,000-99,999 100,000-499,999 =500,000 1 (2.6%) 18 (47.4%) 12 (31.6%) 5 (13.2%) 2 (5.3%) 0 (0.0%) 15 (44.1%) 13 (38.2%) 5 (14.7%) 1 (2.9%) Major resistance mutations DTG associated DRMs G118R +/- (E138K, N155H, R263K) N155H +/- (E92Q) Q148HRK +/- (E138KA, G140A, N155H) R263K PI Major DRMs NRTI..."

Late-breaking abstract • Gene Therapies • Human Immunodeficiency Virus • Infectious Disease

Workplace Safety Considerations in Post-Exposure HIV Prophylaxis: A Case Report of Atypical Hypersensitivity in a Healthcare Worker. (PubMed, Workplace Health Saf) - "We describe the case of a 58-year-old female physician who developed an acute vulvovaginal hypersensitivity reaction within one hour of initiating bictegravir/emtricitabine/tenofovir alafenamide for occupational PEP, followed by drug-induced hypersensitivity syndrome after substitution with darunavir. The case highlights the value of allergy risk stratification in urgent PEP protocols and underscores an opportunity to strengthen sex-specific safety reporting in antiretroviral research. Integrating these considerations into occupational health practice may help prevent life-threatening adverse events, reduce time away from work, and support healthcare worker well-being and productivity."

Journal • Allergy • Hepatitis B • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation

Is the HIV-2 pandemic going extinct 40 years after virus discovery? (PubMed, J Microbiol Immunol Infect) - "Some protease inhibitors, as darunavir, are effective. All integrase inhibitors block HIV-2, and either dolutegravir or bictegravir are the preferred drug choices. Specific viral load tests must be used to monitor HIV-2 plasma viremia. Trends in epidemiological surveys confirm that the HIV-2 pandemic is falling down with less infected persons yearly in endemic regions and globally."

Journal • Review • Human Immunodeficiency Virus • Infectious Disease • CD4

Letter to the editor regarding "Dosing of ritonavir-boosted darunavir for treatment of HIV in pregnancy". (PubMed, AIDS) - No abstract available

Journal • Human Immunodeficiency Virus • Infectious Disease

Risk of Developing Low-Level Viral Rebound Among People With HIV Receiving 2- or 3-Drug Regimens: A Case-Control Study Nested in the ICONA Cohort. (PubMed, Open Forum Infect Dis) - "The cumulative incidence of LLVR after virological suppression was estimated using Kaplan-Meier methods, and conditional logistic regression models were used to evaluate the association between the current antiretroviral therapy regimen (2DR [dolutegravir/lamivudine, dolutegravir/rilpivirine, dolutegravir/doravirine, or cabotegravir/rilpivirine] vs 3DR [dolutegravir, bictegravir, rilpivirine, doravirine, boosted darunavir, or boosted atazanavir-based with a backbone of tenofovir and lamivudine or emtricitabine]) and LLVR risk. After adjusting for confounding, evidence for an association with current regimen was inconclusive (adjusted odds ratio, 0.86 [95% CI, .57-1.29]). Despite the wide range of plausibility, we can exclude a risk of LLVR higher than 29% when using 2DR versus 3DR regimens."

Clinical • Journal • Human Immunodeficiency Virus • Infectious Disease • CD4

Phosphinate pseudopeptide enhances binding free energy in HIV-1 protease by driving flap closure and suppressing global flexibility. (PubMed, Protein Sci) - "This study investigates the molecular mechanisms underlying the binding of three diastereoisomers of the novel phosphinate pseudopeptide inhibitor PAC-Phe-Val (SSSS, SRSS, SRRS) to HIV-1 PR in comparison with Darunavir, a clinically approved inhibitor...These findings identify SRSS as a promising lead compound for HIV-1 PR inhibitor development. Our work provides atomic-level mechanistic insights into inhibitor binding and suggests that future optimization strategies should focus on reducing ligand polarity to minimize desolvation penalties and enhance binding affinity."

Journal • Human Immunodeficiency Virus • Infectious Disease