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Long-Acting Injectable HIV Treatment: What You Need to Know

What it means to “take your HIV medication” has undergone a significant change since the height of the AIDS epidemic in the mid-1990s. Early treatment often included multiple pills that had to be taken at different points throughout the day, requiring a person living with HIV to keep an ongoing schedule for when they would have to take a dose. That eventually gave way to one-pill-once-a-day treatment, which, for many but not for all, has become the standard way of managing HIV. The latest major change in how people take HIV medication came within the past few years, with the advent of long-acting injectable treatments for HIV.

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Articles of Interest

Injectable HIV medications and PrEP

We currently have 3 long-acting injectable HIV medications (Cabenuva and Sunlenca) and 1 long-acting injectable HIV PrEP medication (Apretude) that are FDA-approved and available.

US approves twice-yearly injection for HIV prevention – what you need to know about lenacapavir

Most HIV prevention drugs are daily pills (known as PrEP), which many people struggle to take regularly for various reasons, including inconvenience, price, stigma and side-effects. Lenacapavir works differently. It’s a new type of drug that attacks HIV’s protective shell, stopping the virus from copying itself at multiple stages. In recent years, two other long-acting medicines have been developed for HIV, but neither of them offers protection for a full six months like lenacapavir.

A new injection to prevent HIV, rather than pills, is a game changer, scientists say

The drug, called Apretude but also known as cabotegravir, is an injection that has proven to be significantly more effective at reducing the risk of sexually-acquired HIV. Before the FDA approval on Monday, the more common way to take pre-exposure prophylaxis, commonly known as PrEP, was through a daily pill. Now, an injection only needed once every eight weeks could help mitigate the social stigma of HIV and prevent its spread.

A Promising Injectable for HIV Prevention

Lenacapavir is a first-in-class HIV drug, which means that it has a mechanism of action that has not previously been utilized for HIV treatments. It inhibits what we call the HIV capsid, a conical structure that houses both the genetic material of HIV and the proteins that [the virus] uses to make copies of itself. By interfering with the capsid, the drug prevents HIV from replicating itself into host cells.

Always ‘one atom away’: The long, rocky journey to an HIV prevention breakthrough

Developing lenacapavir, the drug newly approved to protect against HIV for six months in one shot, took basic science, sophisticated chemistry, and perseverance

Can We Stamp Out HIV? New Monthly Injections Could Offer Hope

The new approach, dubbed SPLASH, for Special Program on Long-Acting Antiretrovirals to Stop HIV, provided monthly or bimonthly injections of long-acting anti-retroviral therapies that limited the amount of HIV in patients’ bodies. This is what’s known as “viral suppression,” and it both protects people from the ravages of AIDS and prevents them from spreading HIV to others.

FDA Approves a Twice-Yearly Shot to Prevent HIV

The approval is a milestone in the fight against HIV and could transform the epidemic. While anti-HIV drug treatments have helped millions of people suppress the virus to undetectable levels so that they don’t spread it to others—and have also allowed people who are HIV-negative to maintain their status when used to prevent infection—a regimen of daily pills means that compliance, and therefore effectiveness, is often not as strong as it should be.

Long-Acting Drugs May Revolutionize H.I.V. Prevention and Treatment

New regimens in development, including once-weekly pills and semiannual shots, could help control the virus in hard-to-reach populations.

Protecting Women Against HIV Just Got 9 Times Easier

"What our results show is that cabotegravir was indeed superior to Truvada in preventing HIV infection," she says. Out of the 3,223 women in the study, half were getting Truvada and half were getting the injection. Three years after enrolling in the program, there were 34 HIV infections among women on Truvada versus just 4 in the group getting cabotegravir. This dramatic difference is striking in part because Truvada is already considered in the AIDS community to be a useful prevention tool.

What do we know about injectable HIV medication?

The first complete HIV treatment provided by long-acting injections is a combination of two medications. Cabotegravir belongs to the same class of medication – integrase inhibitors – as the widely used HIV medication dolutegravir. The second medication is called rilpivirine and is already used for HIV treatment in tablet form. It is from a class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Resources

Cabenuva

CABENUVA is a complete prescription regimen used to treat HIV-1 infection in people 12 years and older who weigh at least 77 lbs (35 kg), to replace their current HIV-1 medicines when their healthcare provider determines they meet certain requirements.

Sunlenca

SUNLENCA is an injectable treatment for HIV-1 with a twice-a-year dosing schedule. SUNLENCA can help treat your HIV-1 when used in combination with the other HIV-1 medicines that have been prescribed to you by your doctor.