What do we know about injectable HIV medication?

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Making HIV treatment easier to access by people who need it most is key to ending the HIV pandemic. A relatively new approach that has shown promise is injectable HIV medication. Prior to this, therapy has been a matter of taking pills daily to keep HIV levels down. 

At the moment, two drugs used in combination are the most likely candidates for this new treatment approach. They are cabotegravir, which is an integrase inhibitor and rilpivirine, from the class of non-nucleoside reverse transcriptase inhibitors (NNRTIs).

For the purpose of this article, we are discussing injectables used for the management of HIV (antiretroviral therapy – ART), and not for the prevention of infection (PrEP).

Is this used for starting or changing treatment?

In the development of this treatment regimen, two major trials were conducted. The  ATLAS study recruited people presently on treatment with conventional therapy, while the FLAIR study evaluated starting people on therapy with a combination of cabotegravir and rilpivirine. In both cases, the injectable showed equivalent results in keeping the levels of HIV in the body low when compared with the oral regimen. Potentially, it could be used both for starting and changing therapy by people living with HIV.

Is it available?

The injectable combination has been approved by drug regulators in the European Union, the United States and Canada. However, this does not necessarily mean that the injections are available yet in clinics or that decisions on reimbursement have been made. For example, in England, the National Institute for Health and Care Excellence (NICE) will make a decision later this year.

In Europe, the brand name for injectable cabotegravir is Vocabria, while the brand name for injectable rilpivirine is Rekambys. In North America, the two drugs are packaged together, with the brand name of Cabenuva.

Glossary

therapy

Any form of treatment. Drugs, radiation, and psychiatric counselling are forms of therapy. 

non-nucleoside reverse transcriptase inhibitor (NNRTI)

Non-nucleoside reverse transcriptase inhibitor, the family of antiretrovirals which includes efavirenz, nevirapine, etravirine, doravirine and rilpivirine. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and block HIV reverse transcriptase (an HIV enzyme), preventing HIV from replicating.

regimen

A combination of medications and the way it is taken.

trial

A clinical trial is a research study that evaluates a treatment or intervention with human volunteers, in order to answer specific questions about its safety, efficacy and medical effects.

equivalence trial

A clinical trial which aims to demonstrate that a new treatment is no better or worse than an existing treatment. While the two drugs may have similar results in terms of virological response, the new drug may have fewer side-effects, be cheaper or have other advantages. 

How safe is it?

In the two trials conducted, there were no serious causes for concern as regards safety. The most common reactions were pain at the site of injection and minor irritations. These are common side effects of many injectable drugs.

How often will I need to take it?

The main idea behind the development of the injectable was to have people take them once a month. This will reduce the number of days treatments are taken from the present standard of 365 days to just 12 days a year. A potential concern is that for each treatment day, there has to be a visit to a healthcare professional, making this unattractive for some people.

Another study, the ATLAS-2M study showed the potential of administering the drug every two months. It was still effective at reducing viral load. The European license is likely to allow injections either every month or every two months.

For more information

To find out more, you can read our factsheet on cabotegravir and rilpivirine injections, as well as a research briefing with more detailed information. You can also read all the latest news on long-acting HIV treatment.

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