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Assessing Interest in New Antiretroviral Therapies May Help Inform Uptake & Adherence

In an oral abstract session at CROI 2018, Dr. Nathan Thielman stresses that understanding the interest of HIV-positive treatment-experienced individuals in new antiretroviral therapies may help inform their development and uptake.

Over the past several decades, several advances have been made in the management of HIV; these advances have resulted in improved patient survival as well as quality of life. With the advent of antiretroviral therapy (ART) an HIV diagnosis is no longer equivalent to a death sentence.

Furthermore, fairly recently, the US Food and Drug Administration (FDA) approved the first-ever 2-drug ART regimen for select patients with HIV, Juluca, a fixed-dose tablet, is comprised of two previously approved drugs: dolutegravir (ViiV Healthcare) and rilpivirine (Janssen). Despite these advances, ART adherence rates remain suboptimal in many populations.

In an oral abstract session at the 25th Conference on Retroviruses and Opportunistic Infections (CROI), held in Boston, Massachusetts, Nathan Thielman, MD, MPH, an infectious disease physician and professor of medicine and global health at Duke University, discussed how the development of drugs with extended half-lives along with novel drug delivery systems may be key for dramatically reducing the dosing frequency of ART regimens, which, in turn, could help increase adherence.

The big question is: Will patients be amenable to switching to these new therapies?

To find out, Dr. Thielman and his team conducted a study which analyzed the treatment history and ART preferences of 263 HIV-infected patients from infectious diseases clinics at Duke University and the University of South Carolina. All survey participants were highly treatment-experienced, with a mean of 14.3 years on therapy. Furthermore, 80% of participants were from minority populations, with a mean age of 46.7 years, and almost half of participants (41.4%) had received more than a high school education.

Between February 2017 and August 2017, the participants were surveyed about their HIV treatment experiences and their attitudes toward HIV treatment. They were questioned about their current treatment regimens as well as how interested they would be in switching over to any of the following:

  • A single pill once a week;
  • 2 shots at a clinic every other month;
  • The implantation and removal of 2 matchstick-sized plastic rods in each forearm every 6 months.

Participant supplied ranked responses on a 5-point scale, with 1 being “least interested” and 5 being “very interested.”

The results revealed that those participants who expressed greater interest in switching over to a single pill once a week had also switched treatment regimens in the past. In addition, those participants who had received higher education expressed greater interest in switching over to the use of injection or implants. Lastly, younger participants expressed greater interest in switching to an injectable treatment.

“Across a highly treatment-experienced cohort of HIV-infected patients, we describe greatest interest in switching to an oral regimen taken once weekly, followed by injections taken every other month,” the study authors conclude. “Understanding drivers of preference heterogeneity for new treatment modalities may help to inform their development and predict uptake.”