The European AIDS Conference took place at the end of October. I was amazed to learn about the advances which have taken place in injectable antiretroviral HIV treatments over the past two years.
Antiretroviral treatments are taken by HIV positive people, keeping us healthy by suppressing the levels of HIV in the blood and enabling us to have a normal lifespan. These treatments are mainly taken in the form of daily pills. I take one pill a day, and have few side effects. I have taken my medication like this since a few years following my HIV diagnosis in 2010.
At the end of 2019 there was much discussion around data from clinical trials on the administration of antiretroviral drugs, as well as Pre-Exposure Prophylaxis, through monthly, every two months or bi-annual injections. However, this was still perceived as a future development. The situation now has changed.
On 11 October, the Scottish Medicines Consortium became the first of the four nations’ clinical bodies to approve the injectable treatments, with injections to be administered every two months. However, it is unclear when the treatment will actually be prescribed by NHS Scotland. On 18 November, it was announced that the National Institute for Health and Care Excellence has also approved the introduction of injectable antiretrovirals, to be given every two months, in England and Wales.
The injectable antiretroviral drugs are slowly absorbed and slowly excreted, persisting in the body’s tissues and are effective over a long period of time. As well as injectable antiretrovirals, going forwards there is also the possibility for ultra long term gastric pills, implants and patches.
Canada has been an international leader in terms of injectable antiretrovirals. Injectable antiretrovirals were approved in Canada in March 2020 and have been routinely given to patients from September 2020. The approval in March 2020 was for administration every two months.
Most patients need an oral lead-in phase i.e. a patient cannot be switched directly onto the injectable treatment, without having taken it orally for a month or longer. In one Canadian group, with over 1000 patients on the injectable treatments, virological failure was detected in only 13 participants (a low figure).
There is a preference amongst many patients for the injectable antiretroviral treatments, although a minority returned to oral medications due to “injection fatigue”. Some patients found the injections inconvenient and injection site pain was cited. Injection fatigue was more pronounced in patients accessing the treatment through monthly dosing, as opposed to longer intervals.
There are clear benefits around injectable treatments, including easier long term adherence to treatment for people who struggle with this, reduced exposure to stigma as medication does not need to be kept in the home, accessibility for the homeless and it is a more practical option for those who struggle to swallow treatment.
It is envisioned that patients living with HIV would have the choice to opt-in to this form of treatment. It is about increasing options, rather than taking away oral treatments. I would like every patient to have the option to try injectables if they think it’s right for them. This includes myself – I would be happy to switch or try injectables in the future.
It was a privilege speaking to Michael Brady, HIV consultant and Medical Director at Terrence Higgins Trust:
“The advances in HIV therapy over the last decade or so have meant that treatment is now much easier to take, has far fewer side-effects and we have more options to offer people living with HIV, making it easier to tailor therapy to individual’s needs.
“These advances are one of the reasons why, in the UK, 98% of people diagnosed with HIV are on treatment and 97% have a fully suppressed and undetectable viral load. An undetectable viral load not only protects the immune system from damage and allows it to recover so people living with HIV can expect to live long and healthy lives, but it also means they can be confident that they will not pass the virus on to their sexual partners.
“Injectable therapy is the next stage in the evolution of HIV therapy and, I think, will have a huge impact for people who struggle, for whatever reason, with taking tablets regularly. The research evidence and real-life experience of injectable therapies is very promising with the benefits, for most people, considerably outweighing any potential side-effects or problems.
“As the range of options for treating HIV increases, we will increasingly be able to improve the health and well-being of everyone living with HIV, which will support our aim of ending HIV transmissions in the UK by 2030.”
If you are living with HIV, would like to learn more about HIV or find out about World AIDS Day 2021, I suggest heading to the Terrence Higgins Trust website.