Monthly injections to save patients from oral ARVs

Anti-retroviral drugs. FILE PHOTO | NMG
Anti-retroviral drugs. FILE PHOTO | NMG  

HIV patients tired of swallowing daily oral tablets may soon benefit from alternative long-lasting treatments administered once or twice per month.

Findings of a new phase 2 trial study published in The Lancet journal show that an injectable antiretroviral (ARV) therapy consisting of two drugs (cabotegravir and rilpivirine) — administered every four or eight weeks — may be as effective as a daily oral dose of the drugs in maintaining viral suppression among HIV patients.

The researchers stated that the potential for long-acting injectable ARVs could ease the burden faced by people living with HIV of having to take daily oral medication to manage the disease throughout their lives.

“Adherence to medication remains an important challenge in HIV treatment. Long-acting injectable medicine could provide some patients a more convenient approach to manage HIV infection that avoids daily oral dosing, and the need to keep, store, and transport medications as they go about their daily lives,” stated Dr David Margolis, lead author of the study from Viiv Healthcare in the US.

He said the injectable drugs could represent the next revolution in HIV therapy by providing an option that circumvents the burden of daily dosing.

The results of the study, which involved more than 300 participants, showed that at 32 weeks, viral suppression was maintained in 91 per cent of patients who took daily oral ARV medicine.

But the figure rose to 94 per cent and 95 per cent in people given injectable ARVs once every four weeks and eight weeks respectively.

At 96 weeks, viral suppression was maintained in 84 per cent of patients in the oral medication group, 87 per cent in the four-week group and 94 per cent in the eight-week group.

Dr Margolis noted that even though the results of the drug trials are encouraging so far, further research including on-going phase 3 trials for the new therapy are recommended before the findings can be confirmed applied widely.

The Phase 2 trials were conducted at 50 sites in the US, Germany, Canada, Spain, and France.

Pain at the site of injection was the most commonly reported adverse event by almost all patients given the new ARV therapy. But a majority of the cases were mild or moderate and lasted for three days.

Other side effects of the injectable ARVs included nasopharyngitis — commonly referred to as a cold, headaches and diarrhoea.

About 1.6 million Kenyans are infected with HIV as per the latest official statistics released by National AIDS & STI Control Programme (Nascop) in its 2014 Kenya HIV Estimates Report.

These people require life-long ARV medication to effectively treat the disease and maintain good health.

Health experts warn that poor compliance to the medicines among populations that find it difficult to cope with daily dosage requirements results in treatment failure whilst promoting the emergence of drug resistant HIV.

Network Empowerment of People Living with AIDS in Kenya chairperson Nelson Otuoma said longer acting ARVs are welcome as they would help improve drug adherence.

He, however, noted that injectable drugs that could work for over four months or even a year are preferable.

“Injections will have to be administered in health facilities. So, some people may find it cumbersome to travel many times to hospitals to get the treatment. Yet, oral ARVs can just be taken at the convenience of your house.”

Dr Otuoma stated that to tackle the innate fear of injections that most people harbour, researchers could also look into developing long acting ARV tablets or syrups that can be taken twice or even once a year.

“People are different. So the more options we have out there, the better. And adherence will increase.”

Kenya records about 100,000 new HIV infections each year.