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Friday, December 30, 2016

Injectable anti-HIV drugs could be available in 2017

By Esther Nakkazi

Science is moving HIV treatment and prevention forward from oral to injections. Instead of taking a daily pill for antiretroviral therapy it will switch to an injection lasting three months at most.

Scientists believe, especially women, who are also the most affected by HIV will easily adapt to the use of these long-lasting injectables because of their familiarity with injections through contraception.

Almost one in four new HIV infections in sub-Saharan Africa are in young people aged 15-24 years, and two-thirds of these are among girls who are also users of contraceptives and injectables are favourites.

“When you think about young women, in particular, being very adapted to getting injections for contraception this could be a very nice natural next step,” said Jeanne Marrazzo, the director of University of Alabama at Birmingham School of Medicine Division of Infectious Diseases.

Scientists also believe the injectables will reduce stigma and daily adherence, which is still a challenge to people taking anti-HIV drugs daily and they will also give users a choice.

“Young people sometimes forget to take the pill so if we give them formulations where they do not have to worry it will probably work better,” Thomas Hope, a Professor of Cell and Molecular Biology at the NorthWestern University, Evanston at the biennial HIV Research For Prevention conference (HIVR4P 2016) held 17-21 October in Chicago, USA.

The injectables under development will be used for therapy and for Post Exposure Prophylaxis (PrEP). Two different drugs, Rilpivirine by Janssen Pharmaceutical Companies of Johnson & Johnson and Cabotegravir by ViiV Healthcare, a global specialist HIV company with GSK, Pfizer Inc. and Shionogi Limited as shareholders are collaborating.

For treatment, two injections of Cabotegravir and Rilpivirine will be given in the butt at the same time. While for PrEP, only one injection of Cabotegravir - a new drug to users - will be administered.

“The treatment work is well advanced but prevention is still early,” said Joe Romano, President of NWJ Group, LLC.

Although treatment may be an easy sell to users it will be a challenge for PrEP which communities are less aware of.

“PrEP is more like a contraceptive. It is a product you give to healthy people. Overall, individuals are aware of pregnancy risk all the time and less about HIV risk, which comes on and off,” said Nelly R. Mugo, a gynaecologist and a principal research scientist at the Kenya Medical Research Institute (KEMRI).

But although injections for ARVs may be acceptable there are many technical issues yet to be addressed. Men are still naive in this field and most importantly how long can someone go between the injections, explained Romano.

Scientists are looking at injectables with drugs 3-4 millilitres and for it to last for 1-3 months.

“Men have no experience. Healthy men typically do not get an injection normally every three months,” said Romano.

Then variations in the human body around metabolism, drug absorption are also key as well as being cautious that when an injection goes in it cannot come out!

However, the most pressing issue for injectables for ARVs is the so-called ‘tail’, which basically means if the drug is injected in an individual at what point does its concentration go down so that they are not at risk before the next dose. If the drug levels are down what happens if infections with a bit of drug in the background?

“I think 3 months is good but if it starts to get less than that and you have to go every month to the clinic that is still a hustle,” said Lynn Morris the head of the HIV Virology laboratories at the National Institute for Communicable Diseases (NICD) in South Africa.

ends

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