Looking at the preferences of people with HIV with regard to long-acting injectable antiretroviral (ARV) treatment, a recent small study found that the factors that most drove people’s attitudes were the therapy’s effectiveness and its dosing frequency, aidsmap reports.
The long-acting injectable regimen Cabenuva (cabotegravir/rilpivirine) is currently awaiting approval from the Food and Drug Administration. A decision is expected in the coming weeks. The treatment requires visiting a clinic for an intramuscular (into the muscle) injection every four weeks.
Subcutaneous (under the skin) long-acting injectable ARV regimens that people with HIV can self-inject at home are further back in the pipeline.
Publishing their findings in AIDS and Behavior, a research team led by Jane Simoni, PhD, of the University of Washington in Seattle, surveyed 56 HIV-positive individuals in Seattle and Los Angeles in 2016 and 2017.
To determine their preferences, participants were asked a series of questions involving pairs of choices: injecting at home or a clinic; a dosing schedule of every week or every two weeks; one or two injections per dose; mild or moderate injection pain; mild or moderate injection-site reaction; and an effectiveness comparable or superior to oral ARVs.
The study also asked the respondents to rate each of those scenarios according to how acceptable they were and assigned a score to each of the responses from zero to 100 according to how likely the individuals were to find the scenario acceptable.
The participants had a median age of 52 years old. Seventy-one percent were men, 76% had a high school diploma, 73% were not working and the majority were Black or Latino. Seventy-nine percent rated their adherence to ARV treatment as good, very good or excellent, and the same proportion had a fully suppressed viral load. One in four currently self-injected either prescription medications or street drugs.
Overall, long-acting injectable ARV treatment had an acceptability score of 58, putting it between a “neutral” and “somewhat likely” level of acceptability.
The highest score, 69, went to receiving dual injections in a clinic every two weeks with moderate injection pain, a mild injection-site reaction and greater effectiveness than oral ARVs. The lowest score, 48, went to self-injecting dual doses at home once a week, with moderate injection pain, mild injection-site reaction and comparable efficacy to oral treatment.
The two factors that were the most influential in determining the acceptability of long-acting injectable treatment were superior effectiveness to oral treatment and less frequent dosing.
“Overall, our results suggest that as long as the targeted long-acting combination antiretroviral therapy works as well or better than daily pills and administration frequency is not too burdensome, people living with HIV may be willing to tolerate potential side effects, less preferred injection sites and even moderate adverse site reactions,” the study authors concluded. “It may even be that people living with HIV would even find regimens with comparable effectiveness to oral pills to be preferable under scenarios in which burden can be minimized.”
To read the aidsmap article, click here.
To read the study abstract, click here.