Adding Long-Acting Injectable Options for HIV Management

Following the approval of cabotegravir-rilpivirine earlier this year, experts are looking forward to an expansion of the drug class for HIV.

Perhaps a bit quietly—relative to the authorization and rollout of the first COVID-19 vaccines occurring at that time—the US Food and Drug Administration (FDA) approved the first long-acting injectable antiretroviral therapy (ART) for the treatment of HIV in adults this January.

The approval of ViiV Healthcare’s cabotegravir and rilpivirine (Cabenuva) this year was indeed a milestone in HIV treatment capability—even if the rollout of the treatment since has been less than ideal.

In an interview with Contagion during IDWeek 2021, David Alain Wohl, MD, of the UNC School of Medicine, discussed the challenges of introducing Cabenuva to HIV clinics in the last 10 months. Along with hurdles in seeking patient prior authorization and prescribing confidence, clinicians were burdened with navigating inconsistent patient scheduling during COVID-19.

Though its implementation may begin to improve in practices, Wohl does not see cabotegravir and rilpivirine’s role to be the most optimal long-acting injectable therapy—only the first one.

“The first car wasn’t the fastest, it wasn’t necessarily the sturdiest, gas-friendliest or the most economical,” Wohl said. “It took iterations to make things better. This is our first step through the door for long-acting (injectables). It won’t be our last step.”

Wohl also discussed the potential of future long-acting ART options including lencapavir and islatravir, which lend themselves to combination-regimen capability and provide greater flexibility for treatment frequency.

“These are very promising strategies for people who are not necessarily interested in taking a pill a day for the rest of their lives,” he said. “Anything we do for treatment is going to lend itself to prevention too. I think they go hand-in-hand. The innovations in one can totally help the other.”