In injections or implants, technology that eliminates daily pill taking, and with it “pill fatigue,” stigma, and other barriers to adherence, has already proven its value, and is on the horizon for HIV
SEATTLE – Surveys indicate that the majority of people living with HIV would be happier with a monthly injection than a daily pill. At least five drug candidates are under development now because of their potential to be delivered in long-acting formulations, while existing daily antiretroviral drugs could also be “extendified” to be suitable for longer-acting formulations. Instead of intramuscular injections, the medicines could also be delivered through implants, as some long-acting contraception is now. Developing formulations for children is more complicated but not impossible. And in the end, in formulas that require less of the drug used over time, long-acting extended release antiretroviral medicines could be affordable in low and middle-income countries where they would knock down many existing barriers to treatment retention and adherence.
This is how, one by one, Dr. Charles Flexnor of Johns Hopkins University countered arguments against the feasibility of an approach to treatment that could transform the experience of living with HIV, and with that, efforts to control the virus and its spread. Flexnor, who invented the word “extendify” to express some of the possibilities he described last Thursday in Seattle, supported his points with science, including developments released in symposia and posters through the week.
For all the possibilities long-acting treatments will offer HIV care, he added, the biggest impacts of the advances toward their development will likely be on other diseases.
“Imagine what a long-acting extended release formulation can do for the control of tuberculosis, hepatitis C, hepatitis B, malaria and epidemics like Ebola,” he said. “This is no longer science fiction. This today.”