When Can Clinicians Expect Long-Acting Injectable ART?

Joseph Eron, MD, professor of medicine at the University of Carolina at Chapel Hill, discusses when clinicians may expect to have access to long-acting injectable ART and the different opportunities it offers for individuals with HIV.

Interview Transcript (modified slightly for readability):

"The question about long-acting therapy, it’s a really important one. We have terrific therapies, but they all require that people take pills every day, so there’s been a strong interest in developing long-acting therapy.

We’ve seen phase 2 data on injectable therapy that can either be given monthly or every other month to people who have HIV who have already been suppressed on their current therapy. And that study has now been out over 2 years, 96 weeks, showing that both injectable arms were about as good, maybe even a little bit better, than continued oral therapy. But the proof, of course, is in the larger phase 3 studies. Two large phase 3 studies are ongoing, they’re fully enrolled, and they should reach their primary endpoint in the next year or so. So, realistically, when will it be in the hands of clinicians? I would say probably in about 2 years from now.

As for the therapy, it’s injectable; it’s an intermuscular injection, and so, it’s an injection that has to be given by a health care provider at this point. I think the longer-term goal, which were talking 5 years or more, are therapies that can be given even less often, maybe every 3 months or even maybe every 6 months, and perhaps do not necessarily need to be given in a health care setting or it might be implantable like some contraceptives. And so, that’s what the longer-term future looks like. The short-term future I think is about 2 years for an injectable therapy, provided, of course, that the phase 3 studies meet their mark.

We think it will improve treatment adherence; there are several ways to look at it. It might be particularly good for people who have problems with pills; they’re engaged in care, but they just can’t take pills very well. Also, I think it’s an opportunity to reach people who can’t stay engaged in care and we might need novel ways to reach them. For instance, looking at other ways to administer the drug, can it be done in pharmacies? Can it be done in other health care settings, not necessarily in an HIV-specialized health care setting. Can we even do it in a mobile way to reach out to people using vans or other ways to go out to people to give the therapy?

Yes, adherence is a big goal, but a lot of people just don’t want to take pills—even people who are very adherent. What you’ll hear sometimes is ‘Every day I take pill; every day I’m reminded that I have HIV and I have to take this pill.’ And so, there are some people who are very adherent that prefer to be on an injection, especially if it was every 2 or every 3 months.”