Mexico City.- Antiretroviral treatment (ARV) has developed so positively since its introduction a few decades ago for HIV treatment that of the twenty tablets that patients had to take, today only one, which combines some medications, is sufficient.
A single dose per day was enough to keep the viral load so low that it is no longer detectable. Therefore, with this treatment, HIV was no longer considered a death sentence. “What could be more convenient than that?” asks Chilean infection specialist Claudia Cortés.
“We thought we were okay with it, but the truth is that we need to make things even more pleasant and friendly, since it is a chronic disease that today allows us to have an excellent quality of life, but it depends on the person who who is taking the medication.”, simply so that patients can follow and use the treatment.
“And that led to starting to develop other delivery techniques, other forms of drug distribution that are no longer just pills that are taken once a day,” said Cortés, a scientist at the University of Chili School of Medicine .
With this aim, the so-called long-acting ARV therapy was developed, the administration of which is carried out through a pair of sustained-release injections every two months.
“We went from taking a pill 365 days a year to getting jabs six times a year. This is a big change in the treatment of HIV, it is a change in the treatment paradigm,” emphasizes Cortés, who addressed this issue on September 7 in Mexico as part of the Latina Forum on HIV organized by the Huésped Foundation.
The long-acting ARV therapy, approved in the last two years by US and European regulators – the FDA and the EMA, respectively – consists of the combined use of the drugs cabotegravir and rilpivirine, each injected into one buttock.
Rilpivirine, explains the Chilean infectious disease specialist, is a drug that has been known and used for a long time; Cabotegravir, on the other hand, is a relatively new substance, but belongs to the family of so-called HIV integrase inhibitors, which have been used for more than 10 years.
Although this formula is not a cure for HIV, it keeps HIV infection under control and at the same minimum level as conventional therapy, with the huge advantage of replacing daily pill-taking with a bi-monthly visit to the doctor for injections.
“This brings with it many advantages. We can sort of divide them into biological benefits: better adherence; persistent undetectability, which may even be better than tablets.”
“And being undetectable brings with it an advantage that is not just individual but collective for the patient: a person who has the undetectable virus does not transmit it to other people. We call that I=I, so it’s not demonstrably the same thing.” “Not transferrable,” says Cortés.
Additionally, there are psychological benefits that translate into greater well-being for people living with HIV.
“Taking medication every day reminds me every day that I suffer from this disease, which is highly stigmatized. Therefore, one of the things that patients are most grateful for is that they no longer have this daily reminder,” emphasizes the Chilean infectious disease specialist.
“This is a very important mental health benefit.”
Possible side effects range from simple things like pain, redness, and swelling at the injection site to allergic reactions, liver problems, and depression or mood swings.
Currently, this form of treatment – which it is hoped will advance the technology to the point where it can eventually be self-administered – is available in the United States, Canada, some European countries and Australia.
In Latin America, for example, Chile is the only country where it was launched less than two months ago.
“The public system still doesn’t allow it, mainly because of cost. And in the private system it is only beginning to take hold very slowly,” says Cortés.
“Of course we have the difficulty here that we always have, from an economic point of view. This is a treatment that still costs more than the equivalent of a two-month oral pill,” he says.
When asked about this, the scientist from the University of Chile points out that this is because there are currently no patents for these drugs, which are manufactured exclusively by Janssen, since it is such a new drug, in the case of rilpivirine and for ViiV Healthcare – from Pfizer and GSK – for Cabotegravir, companies that have entered into a collaboration agreement.
“I believe that it is a matter of time, I want to believe that it is a matter of time and that prices will come down at some point,” estimates Cortés, based on what has happened in the past with other drugs used to treat HIV has happened .
When this happens, the expert urges to convey to the population that this new alternative already exists, that it is scientifically based, so that they can take the necessary steps so that the authorities know about it, regulate it and put it into circulation.
Option for the most vulnerable
The combined use of cabotegravir and rilpivirine as long-term ARV therapy was originally indicated for virologically suppressed adults – with fewer than 50 HIV copies per milliliter of blood – and on stable antiretroviral treatment.
“At first it was thought that this was, so to speak, a reward for the well-organized patient who we know will come back in two months to be pricked,” says Chilean infectious disease specialist Claudia Cortés.
“Patients who are already undetectable, who have been treated with other medications for at least six months and have reached this undetectable viral load. And then we switch to intramuscular therapy.”
However, one in San Francisco by Dr. A study conducted by Monica Gandhi recently showed the effectiveness of this treatment in patients with difficult adherence and even positive viral load in various social problems: unstable housing, mental illness and substance use disorders.
“Sex workers, homeless people, people with drug problems. And in this group, which is the highest risk, the drug did well and improved undetectability. As a result, more patients achieved undetectability,” emphasizes Cortés.
“It’s a small study (of 133 people), we need to look longer and see what happens when we leave the study itself when we no longer have an environment that is so controlled – even though this wasn’t a controlled environment . Due to the nature of the population. But it speaks very well for the combination of these drugs, which are very effective.
In women, who are often left out of drug improvement studies, it has been proven that this long-term ARV therapy can be used in any woman over 12 years of age, except in the case of pregnancy.
