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Bimonthly Injections as Effective as Pills at Treating HIV

by John Riley .
Saturday Nov 21, 2015

A recent medical study from GlaxoSmithKline and Johnson & Johnson found that a monthly or bimonthly injection was as effective in suppressing HIV as daily oral medication.

Trial participants were split into three groups, with each receiving oral medication. One group continued to take daily oral medication in the form of three daily pills, including the drug cabotegravir. The second group was given an injection of cabotegravir and rilpivirine once a month, and the third group was given the same injection at two-month intervals.

According to researchers, the patients who received injections had viral suppression rates nearly identical to the patients who took the oral medication. The difference in results - which was not statistically significant - showed that those receiving bimonthly injections had a successful viral suppression rate of 95%, compared to 94% for those receiving monthly injections, and 91% for those on oral medication.

While further studies need to be done, researchers are cautiously viewing the results of the study as a positive development for the treatment of HIV. Paul Stoffels, the chairman of pharmaceuticals for Johnson & Johnson, told Bloomberg Business that the drug used in the injection requires refrigeration and is too large of a dose to be self-administered, as diabetics do with insulin shots.

The biggest breakthrough is that Johnson & Johnson has learned how to take the oral medications and created a new "nano-emulsion" that breaks the medication into tiny particles so that it can be injected and absorbed by the body at a slower, more gradual rate, thereby expanding the time in between injections while also maintaining a constant level of medication in the body.

"One of the biggest problems that continues to make treating HIV very difficult is adherence, getting people to take even one pill a day, every day for the rest of their lives," says David Hardy, senior director of evidence-based practices and research at Whitman-Walker Health. "What this treatment is really being based on is some work that has been done, primarily for birth control.

"In the world of preventing pregnancy, women take a pill every day. But what they have also found is that they can take one of the same medications that is found in a birth control pill, and put into a slow-release device, or into an injection, in a slow-release form, and can inject it into a woman. And she only has to get that injection once every two or three months, and still have the benefits of a daily pill.

"What this is really being developed for is for situations in which a person can't take a pill every day, and for people who have a hard time with adherence," adds Hardy. "It can also be done just for convenience. They can get their injection, and it's done for the next two months. They don't have to go to the pharmacy to pick up their prescription, they don't have to worry about their co-pay, it's all done right there in the doctor's office."

Ron Simmons, president of Us Helping Us, which works in the areas of HIV prevention and treatment and case management for people living with the virus, says injectable medication would be a "blessing."

"In principle, for some people, that would be lifesaving," says Simmons. "The downside would be, is that going to cost more, because now you've got a doctor's visit. But maybe not, if the insurance company is covering it." Simmons adds that more research would have to be done to see how long after the two-month window the shots remain effective, or whether there is some degree of flexibility -- in terms of a few days to a week-long "cushion" -- as to when a follow-up injection is required.

But overall, the benefits of injectable medication would likely be more effective in treating the virus.

"If you're trying to get people to be compliant by taking a pill every day," he says, "it should be easier to get them compliant by seeing a doctor every other month."

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