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Lenacapavir binds within a pocket between the capsid subunits of two different capsid proteins, thereby reducing the flexibility of the interhexamer connections.[52,53,54] Lenacapavir inhibits viral replication at three steps in the HIV life cycle: (1) it disrupts the normal transport of the capsid core through the nuclear pore complex, (2) it prevents the uncoating or disassembly of the capsid, and (3) it interferes with reassembly of the capsid core as part of the HIV maturation process.[52,55] When to Initiate Antiretroviral Therapy Recommendations for Initiation of Antiretroviral Therapy The Adult and Adolescent ARV Guidelines recommend initiation of antiretroviral therapy for all persons with HIV to reduce morbidity and mortality associated with HIV infection and to prevent HIV transmission to others (Table 1).[56] In addition, antiretroviral therapy should be started immediately, or as soon as possible, after the HIV diagnosis.[56] Further, the guidelines emphasize the importance of starting antiretroviral therapy as soon as possible in people diagnosed with acute or early HIV infection, due to both immunologic consequences of delayed initiation and the elevated risk of transmitting HIV during this period.[56] Data for Clinical Benefit of Antiretroviral Therapy The Adult and Adolescent ARV Guidelines recommendation to initiate antiretroviral therapy in all persons with HIV to reduce morbidity and mortality is based on multiple cohort studies and clinical trials, as outlined below

These dose-dependent discomfort symptoms can be alleviated by taking the medication in divided doses or with food

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J Clin Invest (2014) 124(1):398412