Analysis finds that teens who receive injectable HIV treatment manage the condition better
Sarah Boden37 minutes ago.
HIV/AIDS
Teens who got an every-other-month injection for their HIV treatment, and therefore didn't have to take a daily pill, did better at managing their viral load, according to new research published yesterday in The Lancet.
The study involved 476 adolescents, aged 12 to 19, living in Kenya, South Africa, Uganda, and Zimbabwe. All had well-controlled HIV with undetectable viral loads, and nearly all were born with the condition.
Half the adolescents were switched to injectable antiretroviral therapy (ART) that, after an initial ramp-up period, they received at a clinic every eight weeks. The other half continued taking a daily fixed-dose ART tablet, the regimen recommended by the World Health Organization (WHO).
After 96 weeks, just two participants in the injectable group had a rebound of their viral load, but 15 in the control group experienced rebounds.
(The study defined a rebound as when two tests, taken at least seven days apart, show someone's viral load of HIV as being 50 copies of HIV RNA per milliliter (mL) of blood plasma or higher. Clinical guidelines find that when someone's viral load is at 50 copies/mL or below, their HIV is undetectable.)
These findings were a "very welcome surprise," said principal investigator Sarah Pett, DTM&H, PhD, an infectious disease researcher at the University College London.
Pett told CIDRAP News that she initially assumed adolescents on injectable ART would do equally well as those taking the daily oral dose.
Ideally, all teens with HIV have access to injectable ART
The results provide reassuring safety and tolerability data while offering a real-world approach for monitoring viral load, said Natella Rakhmanina, MD, PhD, the director of HIV Prevention and Treatment Services at Children's National Hospital in Washington, DC.Based on these findings, Rakhmanina, who did not contribute to the Lancet study, said she'd like the WHO to recommend long-acting injectable drugs for adolescents whose HIV is virally suppressed.
"Having successfully scaled up the long-acting injectable HIV treatment for adolescents in clinical settings in the USA for over four years," she said, "I am eager to see this treatment being available to eligible adolescents across the globe, especially in regions most affected by HIV."
Elizabeth Lowenthal, MD, MSCE, an expert in pediatric and adolescent HIV infection at the Children's Hospital of Philadelphia, agrees that, ideally, injectable ART should be available to all adolescents, especially those living in communities with high rates of HIV.
Lowenthal, who also did not contribute to the study, told CIDRAP News that, for injectable ART to be available in resource-limited areas, drug costs must be affordable and supply chains must be strong enough to allow uninterrupted access.
"The patients who stand to benefit the most from long-acting injectable options are those who struggle to take daily oral therapy consistently," she said.
A potentially higher quality of life
The study didn't ask participants why they were less likely to have a viral rebound when on injectable ART. However, Pett pointed to other research that's shown adolescents with HIV do worse than adults because of bullying, stigma, and a lack of privacy. She suspects that getting treatment through an every-other-month injectable mitigates some of these challenges.Interestingly, another study published today in Open Forum Infectious Diseases found that patients receiving HIV treatment at clinics in San Francisco, Atlanta, and Chicago also prefer injectable ART.
About three in four of those surveyed said their mental well-being was better when they received treatment via an intramuscular injection, given by a healthcare provider every four or eight weeks, when compared with oral medication.
Not having to remember a daily pill was the top reason people cited for preferring the injection, followed by it being less work than a daily pill.