Nanomedicine could reduce dose and cost of treatment for people living with HIV, early trials show
Initial trials using nanotechnology have shown that people living with HIV could reduce the dose of their medication by up to two-thirds with no loss of effectiveness - which could improve adherence and reduce costs.
People living with HIV could reduce the dose of their medication by up to two-thirds with no loss of effectiveness, according to initial trials using nanotechnology – a manipulation of the matter inside drugs to reduce the size and number of pills – which have produced promising results.
In the first trials using orally-taken nanomedicine to enhance HIV therapy, two small studies used Solid Drug Nanoparticle technology to improve drug absorption in the body, lower the dose and reduce the cost of pills for two types of antiretroviral drugs, lopinavir and efavirenz.
The results with efavirenz, one of the drugs in the current World Health Organization-recommended regimen for people living with HIV, have suggested a lower dose of 400mg could be equivalent to the current first-line dose of 600mg, which is taken by 70% of adult patients on first-line treatment. The dose could even be reduced to 200mg if nanotechnology proves successful in wider trials.
The University of Liverpool led the research as part of OPTIMIZE, an international partnership funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID), which aims to create simpler, safer and cheaper HIV treatment.
Andrew Owen, of the university, said reducing the dose could create production savings of $243 million a year and greatly reduce manufacturing requirements. The focus of the study was on pharmacokinetics – the way drugs move inside a patient’s body.
“Ultimately, what we’re trying to do is match the pharmacokinetic exposure from a lower dose,” he told the Conference on Retroviruses and Opportunistic Infections in Seattle last month.
OPTIMIZE is now supporting clinical trials to fill gaps in data and clear the path for lower-dose combinations to be implemented in global and national guidelines.
“The potential applications for HIV treatment are incredibly promising,” says Benny Kottiri, who leads USAID’s Office of HIV/AIDS Research.
“These integrated investments offer the potential to reduce the doses required to control the HIV virus even further, resulting in real benefits globally.
“This would enable the costs of therapy to be reduced, which is particularly beneficial for resource-limited countries where the burden of disease is highest.”
The study relied upon historical data from two other types of combination medication, Kaletra and Sustiva. The strategy will also be applied to Darunavi and Atazanavir – both protease inhibitors used in antiretroviral treatment for HIV.
Direct comparisons with other types of treatment are planned during the second stage of the research, when Owen expects to discover whether a lower dose will result in a more favourable safety profile for the drugs.
“I think to answer the question of whether there is a potential safety benefit we’ll need many more volunteers and patients,” he said.
Studies have repeatedly associated taking fewer pills with higher rates of adherence to treatment and better virological outcomes. The research team said evaluations carried out among HIV patient groups had shown a willingness to switch to nanomedicine alternatives if the benefits of doing so could be shown.