By Jonathan Lambert
People living with HIV are one step closer to having a once-a-month treatment alternative.
There is no cure for HIV. But combination antiretroviral therapy can effectively stop the virus from replicating. However, for the therapy to work, people must follow a daily regimen of two or more pills, which experts say can be challenging for many.
Results from two phase III clinical trials suggest that a monthly injection of antiretroviral drugs works as well as daily pills, researchers reported in two studies published in the New England Journal of Medicine on March 4. If approved by regulators, the therapy could be a convenient treatment for approximately 1.1 million people living with HIV in the United States.
“From the patient’s perspective, these results are very positive,” says Elizabeth Tolley, an epidemiologist with FHI 360, a nonprofit public health organization based in Durham, North Carolina. A monthly alternative might be a better option for many.
The injectable ART is a long-acting combination of cabotegravir and rilpivirine. One of the clinical trials was led by Chloe Orkin, an HIV researcher at Queen Mary University of London. It enrolled 566 treatment-naïve participants who started with oral therapy, which included a combination of other HIV medications, for 20 weeks to control the virus. Participants then transitioned to monthly injections or continued oral therapy.
The other trial, led by Susan Swindells of the University of Nebraska in Omaha, enrolled 616 participants whose HIV had already been controlled with oral therapy.
In both trials, participants were randomly assigned to receive the monthly injection treatment or continue taking pills. After 48 weeks, there were no significant differences in viral load between participants for each treatment, suggesting that the monthly injections work as well as the pills. Most patients reported some pain or swelling with the injection.
"There are advantages and disadvantages" to each option, says Marc Siegel, an infectious disease physician at George Washington University in Washington, D.C. "The patient won't have to remember to take a pill every day, although they will have to visit the doctor's office once a month."
Monthly injections may be more feasible for people struggling with housing instability who don't have a place to store pills, Siegel says. "If we can find a way to help these people get to a clinic, we could reach a group that has been harder to treat."
In two clinical trials, a monthly injection of antiretroviral drugs was shown to be as effective as a daily oral regimen in controlling HIV.
References:
C. Orkin et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. New England Journal of Medicine. Published online March 4, 2020. doi: 10.1056/NEJMoa1909512.
S. Swindells et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. New England Journal of Medicine. Published online March 4, 2020. doi: 1
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From: https://www.sciencenews.org/article/hiv-monthly-treatment-antiretroviral-therapy-shot