Cabenuva – A Long-acting injectable HIV regimen

What the news of a long-acting, injectable antiretroviral therapy means for LGBTQ people living with HIV.

Health Sexual Health Simon Elstad

This article was published on March 2nd, 2021

For adults living with HIV, sticking to a daily routine of antiretroviral drugs can prove burdensome. It becomes more toxic when they grow older, especially if they are on other medications. But the situation could change soon with the advent of a long-acting injectable treatment that doesn’t need to be taken daily.

On January 21st, the US Food and Drug Administration (FDA) approved an injectable drug, Cabenuva, to treat HIV infection in adults. Cabenuva, made by GlaxoSmithKline’s HIV division, ViiV Healthcare, is meant to serve as an alternative to the antiretroviral regimen taken daily.

The long-acting injection contains two active ingredients: cabotegravir and rilpivirine, which have proven effective as the daily oral option.

The drug, which has been termed as a major advancement in HIV treatment, will be administered as two injections of Cabotegravir and rilpivirine once a month.

Patients will first be required to take an oral dose of the two ingredients to test their reaction to the medications before getting the injectable treatment. The treatment has been recommended to patients who are virally suppressed and not hypersensitive reactions to the two drugs.

Clinical trials on 1, 1182 HIV-positive adults who had viral suppression before taking Cabenuva, showed continued suppression of the virus on the conclusion of the study. The adults exhibited a few common reactions to the treatment, including fatigue, fever and nausea.

The injection has proven a massive relief for patients on the daily oral therapy, with nine out of ten patients preferring it over the pills.

Stigma

The injectable therapy represents a profound shift in HIV treatment due to the significant reduction in dosing days from 365 days to just 12 days a year. For HIV-infected people among the LGBTQ community, the news of the new drug couldn’t have come at a better time.

The community has particularly been plagued by HIV-related stigma and discrimination, hampering the fight against the AIDS epidemic. This has impacted them negatively, affecting their emotional well-being, testing behaviour, medication and general health.

This often sees them engaging in risky sexual behaviours that hasten its spread to their HIV-negative peers. There’s also the aspect of self-stigma where a patient is psychologically burdened by taking pills daily, reminding them that they still have the virus. 

The arrival of this long-lasting anti-AIDS drug could reduce such induced stigma as a few visits to a healthcare facility for injections seem far much discreet than taking daily oral pills.

The long-lasting injection has also been deemed effective in HIV prevention. In the US, 1.14 million are HIV-positive with gay and bisexual men accounting for 648,500 cases. They also represent 68% of new annual HIV infections.  The new injection could be vital in suppressing the number of new infections among gay people.

69% more effective

Currently, treatments like pre-exposure prophylaxis (PrEP), under the brand name Truvada, act as an HIV preventive therapy. However, adherence to the dose could prove challenging as it involves taking a pill daily, thus the idea of a long-lasting injectable drug. A HIV prevention study showed that the drug, Cabotegravir, was 69% more effective at preventing HIV infection than Truvada. The injection is given once every two months.

Cabenuva could soon be made commercially available worldwide, with several countries, including Australia and Switzerland, still reviewing its effectiveness.

It was first approved in Canada, with the European Union also giving it the greenlight. Even as the quest for a HIV vaccine continues, the breakthrough development in this new treatment will be music to the ears of many HIV-patients globally.

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