Antiretroviral therapy (ART) has revolutionised the fight against the human immunodeficiency virus (HIV). An HIV-positive individual that adheres to their daily dose of ART medications can lead a long and productive life. In fact, this adherence is the key to achieving full viral suppression and getting the viral load to undetectable levels.
Adherence, however, can be a problem for some.
World Health Organization (WHO) research suggests that adherence rates in the US come between 70 and 89 per cent. The figures are similar for various other parts of the world that have readily available ART programmes.
Active drug use has been one of the main factors associated to poor adherence. Additional issues that may interfere with a person’s ability to stick to therapy include sociodemographic factors, psychological issues, a patient’s experience during HIV treatment and treatment specifics (like pill burden, dosage, frequency of having to take ART pills, etc.).
The medical community has been actively seeking ways to improve adherence, thus guarantee better outcomes for HIV-positive individuals. A study about injectable ART suggests that it may be one good alternative to the daily pill, as far as sticking to a regimen is concerned.
Injectable ART – Making It Easier to Stick to Meds
Long-acting injectable antiretroviral medications improve adherence rates among HIV-positive people who struggle with their daily pill, research presented during the Association of Nurses in AIDS Care 2023 annual meeting suggests.
The treatment has established itself as a safe, well-tolerated option. It performed equally well among patients of different genders and ages.
It’s important to point out the fact that this particular form of long-acting injectable ART can achieve 84 per cent viral load suppression. Still, it is considered an excellent choice for those who are having issues taking their daily pill.
Poor adherence is one of the key contributors to increased viral loads. There have also been instances of HIV-positive patients that hide their conditions from others. As a result, these people find it very difficult to take their ART consistently and according to a predetermined schedule.
What’s Injectable ART?
The US Food and Drug Administration (FDA) approved long-acting cabotegravir and rilpivirine as a form of injectable antiretroviral therapy in 2020.
The injection is administered either monthly or bi-monthly during a visit to a medical facility. Because it needs to be taken less frequently, injectable ART has already become the choice of preference for some HIV-positive patients in the US.
In 2021, FDA extended the use of the injectable combination to HIV pre-exposure prophylaxis (PrEP).
The study quoted above involved 52 HIV-positive people who switched from oral ART to the long-acting injectable form. Additionally, 16 people chose this form of PrEP over the pills.
Out of all participants in the study, only one went back to oral ART in the end of the trial. All other participants reported a high level of satisfaction with the long-lasting injectable antiretrovirals.
Of all participants, 100 per cent were capable of maintaining their undetectable status after switching to the injectable ART. All 16 study participants who chose the injectable PrEP maintained their HIV-negative status.
The researchers concluded that long-acting injectable antiretroviral therapy is a very successful option for those who experience adherence issues. In order to deliver optimal outcomes, however, the injection programme has to be personalised and built by a dedicated healthcare team. To maximise success, such a team will need to have a few members – a nurse who’s available to administer the injections according to schedule, a medical professional to authorise and prescribe the medications, as well as a dedicated consultant who will be responsible for tracking and following up with a patient.
Understanding the Limitations
While injectable ART provides another weapon in the arsenal against HIV, it has a number of limitations that have to be considered.
For a start, self-administration isn’t possible at the time being. This isn’t the kind of sub-cutaneous injection that most people will be capable of giving themselves. A monthly or bi-monthly visit to a clinic will still be required.
Also, the viral suppression being achieved with injectable ART is lower than what a daily pill regimen can achieve. For those who have no issues adhering to a daily medicine routine, oral ART is still the best option.
There are also certain groups of patients that injectable ART isn’t suitable for. People who have an active hepatitis B co-infection are not good candidates for long-acting injectable antiretrovirals. Pre-existing resistance to the two medications used in the injection is also an indicator against the administration of this ART form.
The safety of the medicines during pregnancy and breastfeeding hasn’t been established yet, which is why that particular group of women is also excluded from the potential candidates.
Luckily, several other forms of highly reliable ART are readily available.
Antiretroviral medications in Singapore can be acquired at a licensed medical facility like Shim Clinic. Shim Clinic also provides reliable STD testing and HIV testing opportunities, as well as fully confidential consultations with our experienced staff members.
If you are worried about your HIV status or you’d like to help out someone that you know, visit the facility during working hours every day of the week or contact Shim Clinic now.