Could Long-Acting Injectable Meds Soon Replace Daily Pills for HIV Maintenance Therapy?
People living with HIV (PLWHIV) should be excited to know that, according to experts, in three to four years long-acting antiretroviral therapy (LA-ART) may be available as maintenance therapy. Put quite simply, that means that many PLWHIV may be able to ditch their daily pills and receive a less frequent injection as their medication. Right now, the closest LA-ART to market includes a new drug called cabotegravir (chemically close to the oral drug Tivicay [dolutegravir]) and is being developed both as a daily oral pill and as a monthly long-acting injectable.
Because for now the research focuses on LA-ART as maintenance therapy, it may not be immediately useful for those with adherence challenges or tricky-to-suppress HIV. Maintenance therapy is a form of HIV therapy that PLWHIV could use only after achieving an undetectable viral load through a standard three- or four-drug regimen. Only then would they move to a two-drug regimen to maintain their suppressed viral load. The combination being considered for maintenance would consist of cabotegravir plus Edurant (rilpivirine).
"There are some data that show that two-drug maintenance drugs do work," said Paul E. Sax, M.D., clinical director of the HIV Program and Division of Infectious Disease at Brigham and Women's Hospital and professor of medicine at Harvard Medical School. Sax is the coauthor of a recent article in Clinical Infectious Diseases that looked at the clinical role and cost effectiveness of long-acting antiretroviral therapy.
Sax advised that an introductory "onboarding" period, during which people would use the daily, oral version of the drug combination, would help ensure that they aren't allergic to either of the two drugs that would be injected. This is because, if a patient immediately switched to the long-acting injectable version and had a bad reaction to one of the drugs, it could stay in the body for weeks and potentially hit the user with adverse health effects.
According to Test Positive Aware Network, two potential pitfalls of long-acting injections are build-up of toxicity over time, and drug resistance from exposing HIV to a long period of low-dose drugs if follow-up injections aren't done in a timely manner.
As the drugs are still in development, we await answers to these questions and concerns. However, for those who struggle with adherence, a form of non-oral, non-daily therapy could become be the key to a long-term undetectable viral load and a better quality of life.