Monthly injections could replace daily pills for people with HIV

Daily pills may become a thing of the past for people who have HIV. A long-acting injection has been found to work just as well or better than standard pill-based antiretroviral therapy (ART) at preventing the virus from bouncing back and becoming infectious again.

At the end of a two-year trial of 286 people with HIV, 94 per cent of those who had injections of the long-acting therapy every eight weeks had the virus under control, defined as having less than 50 copies of the virus per millilitre of blood. A monthly form of the injection was effective in 87 per cent of those who had it, while standard ART pills worked for 84 per cent of those who took them.

The results were unveiled today by Joseph Eron, of the University of North Carolina, at a conference of the International AIDS Society in Paris.

“This is a big step forward,” says Mahesh Mahalingam of the United Nations Programme on HIV/AIDS. “It will help remove the challenge of taking tablets every day and significantly improve the quality of life of people living with HIV.”

Slow release

The treatment is a suspension of two antiretroviral drugs called cabotegravir and rilpivirine. When injected into the buttock, the drugs collect between muscle fibres and slowly leach out into the bloodstream. “A single dose can last for 48 weeks or more,” says Peter Williams of pharmaceutical firm Janssen, who helped lead the project.

Only two people dropped out from having the injections. Although some reported soreness at the injection site, almost all the participants were happy with the injection compared with taking pills, says Williams.

An injected ART could be particularly useful for people with a more chaotic lifestyle or in places where HIV stigma can make people nervous of being seen to take pills, says Williams. “It remains to be seen how many want to go this route.”

“To me, this is a step in the direction we’ve been leaning for some time,” says Anthony Fauci at the US National Institute of Allergy and Infectious Diseases in Maryland. “It’s most beneficial for people who have difficulty sticking to their pill treatment. This way, you don’t run out of anything.”

Michael Brady, medical director of the Terrence Higgins Trust charity in the UK, agrees. “We welcome the prospect of injectable therapy, which will further increase choice and, for many, will be preferable to taking tablets,” he says.

Journal reference: The LancetDOI: 10.1016/S0140-6736(17)31917-7

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