How long-acting ARV injectables work

HIV treatment has over the years evolved from as many as 15 pills taken in one sitting to the current daily combination tablet.

However, the daily pill is still burdensome and the long-acting injectable is expected to be introduced in Kenya soon.  

In Australia, the Therapeutic Goods Administration has approved an injectable treatment called Cabenuva, an injectable drug combination consisting of a long-acting Cabotegravir and Rilpivirine. It is received once every eight weeks to treat HIV.

However, the treatment has been approved to only be used by adults and not adolescents.

Beatrice Nyagol, a research officer at Impact Research,  a local non-profit based in Kisumu, said that there is a current study that is getting long-term injectable treatment for adolescents.

Nyagol said the injectable treatment works in a way similar to contraceptives. 

“The long-term injectable contraceptives is usually released slowly in the body; once it is injected, it rises steadily to the protective level and it can be sustained for a longer period in the body,” she said.

Nyagol said that once the injection gets concentrated, it takes eight weeks to prevent the body from infection.

The drug comes as a relief to patients because they do not have to take the daily pills, which can be inconvenient and embarrassing if one hasn't disclosed his or her condition.

However, Nyagol said people living with HIV will first need to use the daily pills before they can be placed on injectables.

“For a person who has never used the injectable, they are supposed to use the tablets for the first four weeks in order to allow the body to get used to the drugs. After four weeks, a person is now allowed to use injection for the remaining six weeks,” she said.

She said the injectable can only be dangerous in the body if used without preparing the body to receive it.

For the injectable to work steadily in the body, one has to use the combination therapy where another pill must be used because HIV, according to the researcher, can change or mutate.

“The only two pills which are approved to be used along with the Injectable are Cabotegravir and Rilpivirine for prevention of the infections in the body,” she said.

Justas Pre-Exposure Prophylaxis works 99 per cent with proper adherence, Nyagol said the pills or injections work better in women; 89 per cent are protected.

In men, studies have not revealed the percentage of prevention in their bodies.

However, pregnant women are not allowed to use the injectable treatment because they are not allowed to use Cabotegravir.

“The safety of the injectable treatment in pregnant women is not yet established although the studies are being done. Theywill only be allowed to use after further studies are conducted,” she said.

The leading long-acting injectable Cabotegravir and Rilpivirine have been evaluated as a two-drug maintenance regimen that could be used after a person with HIV achieves an undetectable viral load with oral triple-combination ART.

(Edited by V.Graham)