Radboud Annals of Medical Students

RAMS

  • Home
  • Sign up – Masterclasses 2023!
  • News
    • Newsletter archive
  • About
    • RAMS
    • The Board
    • The General Board
      • The General Board (2022-2023)
      • Previous General Boards
    • The Editorial Board
      • The Editorial Board (2022-2023)
      • Previous Editorial Boards
    • The Supervisory Board
    • Reviewers and Editors
    • RAMS Committees
      • Symposium Committee
      • Masterclass Committee
  • Editions
    • 2021-2022
      • Twentieth Edition – September 2021
      • Twentyfirst Edition – December 2021
      • Twenty second Edition – March 2022
    • 2020-2021
      • Sixteenth edition – September 2020
      • Seventeenth edition – December 2020
      • Eighteenth edition – March 2021
      • Nineteenth Edition – June 2021
    • 2019-2020
      • Fourteenth edition – December 2019
      • Fifteenth edition – April 2020
      • Sixteenth edition – September 2020
    • 2018-2019
      • Eleventh Edition – September 2018
      • Twelfth Edition – January 2019
      • Thirteenth edition – May 2019
    • 2017 – 2018
      • Ninth Edition – November 2017
      • Tenth Edition – February 2018
    • 2016-2017
      • Sixth Edition – November 2016
      • Seventh Edition – March 2017
      • Eighth Edition – July 2017
    • 2015-2016
      • Third Edition – November 2015
      • Fourth Edition – March 2016
      • Fifth Edition – June 2016
    • 2014-2015
      • Pilot Edition – June 2014
      • First Edition – January 2015
      • Second Edition – June 2015
  • For Authors
    • Submit your Article
    • Research internship
  • For Supervisors
  • For Reviewers
  • Contact
  • Privacy policy
  • Cookiebeleid (EU)
Je bent hier: Home / News / The use of long-acting antivirals in HIV treatment

The use of long-acting antivirals in HIV treatment

16 mei 2021 by Rams

Thomas Nieuwenstein, BSc Biomedical Sciences

Human Immunodeficiency Virus (HIV) treatment has come a long way since the introduction of the first anti-HIV treatment – azidothymidine, or better known as zidovudine, a nucleoside reverse transcriptase inhibitor – in 1987 [1]. While the drug proved to be effective at reducing opportunistic infections and AIDS-related deaths, it caused severe adverse effects in the patient population [1]. Since then, new drugs have been developed which have turned HIV into a chronic affliction rather than a death sentence [1]. Depending on which regimen is followed, the current treatment consists of one or more pills per day. Adherence to the dosing regimen is key in HIV treatment, as the virus may develop resistance to the medication in non-virologically suppressed individuals [1]. Long-acting antiretroviral drugs may offer a solution by eliminating the need for daily oral therapy [1, 2].

In January 2021, the European Medicines Agency approved the first combination of sustained-release injections of non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine and integrase inhibitor (INI) cabotegravir for marketing [3]. Rilpivirine inhibits the HIV’s reverse transcriptase enzyme, preventing the HIV RNA from being converted into DNA. Cabotegravir inhibits the integrase enzyme, preventing HIV DNA from being integrated into the human DNA. So far, this treatment can only be used in patients who are already virologically suppressed (<50 copies of HIV-1 RNA per mL blood) and have not developed any resistance against NNRTIs or INIs. After a four-week oral lead-in period, the injections must be given intramuscularly into the gluteus muscle once every four weeks, or once every other month, depending on the dosing schedule. If a dose cannot be administered at the designated interval, the extra time can still be bridged with oral therapy. Long-acting injectable therapy of rilpivirine and cabotegravir is indicated as non-inferior to daily oral therapy of the same drugs [4]. The use of the long-acting injectables greatly reduces the medicinal burden compared to the usual daily oral therapy.

Sadly, non-adherence or dropping out of a long-acting injectable regimen is a much larger problem than in oral therapy. As the injections have a sustained release mechanism, concentrations of cabotegravir and rilpivirine can still be measured in the blood up to a year later. As these concentrations are too low to provide virological suppression, there is a high chance that the virus will develop resistance to cabotegravir or rilpivirine if viral suppression is not achieved through other means, such as oral therapy. This means that the patients will not be able to use these long-acting injectables anymore. This may extend to other drugs in the NNRTI or INI drug class. Patients who cannot or will not continue the long-acting injectable treatment schedule should start on other (oral) treatment as soon as possible to minimize the risk of developing resistance. 

The long-acting injectables have another downside, as the injectables also have more side effects, such as pain at the injection site due to the thick needle or other local reactions, on top of the drug-related side effects shared with their oral counterparts [4]. 

Apart from the clinical treatment of HIV, long-acting injectables have shown to be beneficial as pre-exposure prophylaxis (PrEP) for at-risk populations, such as healthcare workers, men who have sex with men, or sex workers, to prevent infection with HIV in the first place [5]. Oral PrEP is already available but is not used often by those who could benefit most from it due to the burden of daily oral treatment. The use of monthly, or once every two months injections may be more acceptable to the populations that may benefit from PrEP and lead to a higher efficacy of PrEP treatments [5].

Overall, the long-acting injectables offer advantages over daily oral therapy but are only approved for a limited population thus far. The population for whom these long-acting injectables are currently approved are already the least vulnerable HIV-infected population (must be virologically suppressed and have good adherence to oral therapy). Exploring the options long-acting injectables could offer in more vulnerable populations, such as those that frequently forget their oral therapy, could have an even larger impact. Possible new solutions also cover other combinations of HIV drugs or non- or less invasive methods of drug delivery, such as skin patches. Research concerning expanding the population and expanding the arsenal of injectable agents is the next step in HIV treatment.

References:

[1] Tseng, A., et al. The evolution of three decades of antiretroviral therapy: challenges, triumphs and the promise of the future. Br J Clin Pharmacol 79, 182-194 (2015).

[2] Margolis, D.A. & Boffito, M. Long-acting antiviral agents for HIV treatment. Curr Opin HIV AIDS 10, 246-252 (2015).

[3] Balfour, H. First long-acting HIV treatment approved in Europe.  (2021).

[4] Swindells, S., et al. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med 382, 1112-1123 (2020).5. Soriano, V., et al. Long-acting antiretroviral therapy. Nat Mater19, 826-827 (2020).

Categorie: News, Uncategorized

RAMS Newsletter

RAMS complies to the GDPR. By submitting your e-mail address to us you agree with our Privacy Policy.

Social Media


Sponsors & Partners

  • Brian Gardner
  • Lauren Mancke
  • Nathan Rice
  • Nick Croft
  • Rafal Tomal
  • Ron Rennick
© Copyright 2014 RADBOUD ANNALS OF MEDICAL STUDENTS · All Rights Reserved · Powered by PLatform11
We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept All”, you consent to the use of ALL the cookies. However, you may visit "Cookie Settings" to provide a controlled consent.
Cookie SettingsAccept All
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Altijd ingeschakeld
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDuurOmschrijving
cookielawinfo-checkbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
OPSLAAN & ACCEPTEREN
Aangedreven door CookieYes Logo