Long-acting antiretrovirals and HIV treatment adherence

Abstract

Intramuscular injection of long-acting cabotegravir and rilpivirine is a novel, long-acting antiretroviral therapy (ART) combination approved for use as a fully suppressive regimen for people living with HIV. Long-acting cabotegravir with rilpivirine ART has reduced required dosing frequency from once daily to once every month or every 2 months injections. This new era of long-acting ART, which includes other antiretrovirals and formulations in various stages of clinical development, holds tremendous promise to change the standard of HIV treatment. Although long-acting ART has high potential to be revolutionary in the landscape of HIV care, prevention, and treatment cascade, more data are needed to substantiate its efficacy and cost-effectiveness among patients at risk of non-adherence and across age groups, pregnancy, and post partum. Advocacy efforts and policy changes to optimise a sustained, high-quality, equitable reach of long-acting ART, especially in low-income and middle-income countries where most people living with HIV reside, are needed to realise the full benefits of long-acting ART.

Figure:. Individual participant log-linear regression curves of plasma cabotegravir concentrations using time between the maximum measured concentration and the last quantifiable concentration after the last injection by sex assigned at birth

Male participants (A). Female participants (B). Curves were fitted for each individual extrapolated to the intersection with LLOQ and all extended beyond the observed concentrations. Dots represent individual participants’ values based on days elapsed since the last injection. Horizontal dashed lines show estimates of protection based on the simian-human immunodeficiency virus challenge model indicating proportion of rectal or vaginal challenges protected for males and females, respectively. LLOQ=lower limit of quantification. PA-IC₉₀=protein-binding-adjusted 90% inhibitory concentration. Reproduced from Landovitz and colleagues, by permission of the authors.