Injectable antiretrovirals: a game-changer for HIV treatment

What are HIV injectables?

Injectables provide medication in injection rather than tablet form. The medication stays in the body longer so people can get an injection less often than taking pills. This is why they are sometimes referred to as ‘long-acting injectables’.

A long-acting antiretroviral (ARV) injectable has been approved for use (or will soon be approved) in the European Union, the United States, Canada and the United Kingdom.

Other forms of HIV-related injectables are also being developed, such as PrEP in injection form.

How does an ARV injectable work?

Clinical trials have found that offering two separate injections of the antiretroviral drugs cabotegravir and rilpivirine every one to two months work as effectively as taking daily antiretroviral tablets.

In the UK, the treatment will only be offered to people who are already virally suppressed after taking ARV tablets and show no signs of being resistant to antiretroviral drugs.

Is injectable HIV medication safe?

Two trials have been conducted on this injectable so far (ATLAS and FLAIR). Both reported no serious side effects. The side effects that were observed were common for any injections, such as feeling sore from the needle.

What are the benefits of ARV injectables?

Taking ARV pills at roughly the same time each day can be difficult to remember and people can run out.

For some people, the stigma associated with HIV causes them to take their HIV medication in secret, which can also make it difficult to stick to. Others find having to take pills daily can have a negative effect on their mental health.

Getting an ARV injection every month or two might be more convenient and discreet for people. Reducing the number of days treatment is taken to just six to 12 days a year rather than daily. This means people might be more able to stay on HIV treatment, which will protect their health and prevent onward transmission.

Are there any drawbacks?

Injectables require a visit to a nurse or a doctor every time a person needs an injection. This might not be suitable for everyone.

What does this mean for HIV treatment where I am?

Trials of injectable ARVs (also using cabotegravir and rilpivirine) have begun in other parts of the world, but it will still be some time before injectable ARVs are widely available.

In Africa, a trial that will involve around 500 people began in Uganda in October. Kenya and South Africa are expected to join the trial by the end of the year.

Announcements of trials in Asia and other regions have yet to be made.