Rukobia (fostemsavir), the only HIV attachment inhibitor, maintains durable viral suppression for five years. The Phase III BRIGHTE trial evaluated Rukobia in heavily treatment-experienced people with multidrug-resistant HIV who were unable to build an effective regimen using existing drugs. A randomized cohort of 272 participants received twice-daily Rukobia plus an optimized background regimen, which included at least one fully active drug; 99 people with no fully active drugs were enrolled in a nonrandomized cohort. At 48 weeks, 54% of Rukobia recipients in the randomized cohort and 38% in the nonrandomized cohort had an undetectable viral load. At 240 weeks, 45% and 22%, respectively, had viral suppression. When excluding people who discontinued Rukobia or lacked data, response rates rose to 82% and 66%. Mean CD4 cell gains at five years were 296 and 240 in the two cohorts, and most people who started with less than 50 cells reached a count of 200 or more. What’s more, participants saw improvements in biomarkers associated with comorbidities and mortality.