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Moreno C, Izquierdo R, Alejos B, Hernando V, Pérez de la Cámara S, Peraire J, Macías J, Bernal E, Albendín-Iglesias H, Alcaraz B, Suárez-García I, Moreno S, Jarrín I. Acceptability of Long-Acting Injectable Antiretroviral Treatment for HIV Management: Perspectives of Patients and Physicians in Spain. AIDS Patient Care STDS 2024. [PMID: 38916077 DOI: 10.1089/apc.2024.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
We assessed the prevalence and factors associated with HIV-infected patients' interest in trying long-acting injectable antiretroviral treatment (LAI-ART) along with its expected benefits and concerns, and evaluated physicians' opinions about LAI-ART. This study was set within the multi-center prospective CoRIS cohort, comprising HIV-positive adults, naïve to antiretroviral treatment (ART) at study entry, recruited from 2004 onward in 48 centers in Spain. In June 2022, we conducted a 2-day cross-sectional survey among patients across 34 CoRIS centers and sent an online questionnaire to all physicians prescribing ART in 39 CoRIS centers. Of the 271 patients included, 83.3% [95% confidence interval (CI)]: 78.0 - 87.0%) expressed interest in receiving LAI-ART. This interest was higher among men (adjusted odds ratio: 2.96; 95% CI: 1.4-6.12), those aged <50 years (2.41; 1.23 - 4.73), and individuals inconvenienced by oral ART (5.03; 1.47 - 17.15), daily intake (14.65; 3.44-62.46), carrying HIV pills constantly (7.19; 2.88 - 17.96), and taking multiple medications (3.94; 1.58 - 9.85). Among the 154 physicians surveyed, 45.5% believed LAI-ART would be the preferred option for patients. Although most physicians (92.9%) thought LAI-ART could improve patients' quality of life (QoL), concerns were raised by 37.7% and 44.2% of them regarding injection site pain and visit rescheduling, respectively. Interest in LAI-ART was higher among men, those aged <50 years, and individuals finding their oral ART inconvenient. Physicians believed LAI-ART could improve QoL and overcome treatment challenges, yet concerns were raised about its potential usage difficulties. Although most patients were interested in receiving LAI-ART, only less than half of the physicians considered it their preferred option, likely owing to concerns about missed visits and injection site pain.
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Affiliation(s)
- Cristina Moreno
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | - Rebeca Izquierdo
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | | | - Victoria Hernando
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | | | - Joaquim Peraire
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Pere Virgili Institute for Health Research (IISPV), Joan XXIII University Hospital, Rovira and Virgili University, Tarragona, Spain
| | - Juan Macías
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Department of Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville, Virgen of Valme University Hospital, Seville, Spain
| | - Enrique Bernal
- Department of Infectious Diseases, Reina Sofía General University Hospital, Murcia, Spain
| | - Helena Albendín-Iglesias
- HIV and STI Unit, Internal Medicine Department, Virgen of Arrixaca University Hospital, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Begoña Alcaraz
- Infectious Diseases Unit, Internal Medicine Department, Santa Lucía General University Hospital, Cartagena, Spain
| | - Inés Suárez-García
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Infectious Diseases Group, Department of Internal Medicine, Infanta Sofía Hospital, Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), European University of Madrid, Madrid, Spain
| | - Santiago Moreno
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Ramón y Cajal Health Research Institute (IRYCIS), University of Alcalá, Madrid, Spain
| | - Inma Jarrín
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
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Agarwal H, Huffstetler HE, Lopez C, Go VF, Napravnik S, Farel CE, Rutstein SE. "I Feel Like I Don't Even Have HIV Anymore"-Facilitators, Barriers, and Experience regarding Use of Long-Acting Injectable Antiretroviral Therapy Among Persons with HIV in North Carolina. AIDS Patient Care STDS 2024. [PMID: 38860413 DOI: 10.1089/apc.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
As access to long-acting injectable antiretroviral therapy (LAI ART) expands, understanding patient perceptions and experiences around LAI should inform equitable scale-up and effective implementation strategies. This study used qualitative research design relying on semi-structured interviews conducted among persons with HIV (PWH) who were either virally suppressed on oral treatment (n = 11) or had received at least one dose of injectables (n = 7). Approximately half of participants identified as male (10/18) and most identified as African American (17/18). Among participants on oral ART, many described the prospect of injectable treatment as likely convenient and discreet, relieving the stress of remembering to take daily pill. Nearly all had heard of LAI ART prior to the interview, often from television or internet commercials. Most were excited about less frequent dosing, though expressed concern about the logistics involved in coming to clinic every two months. Many expressed uncertainties regarding the relative effectiveness of LAI ART compared with oral therapy and were wary of potential pain related to injections. In contrast, all persons on LAI ART described injection-site soreness as manageable. In addition to acknowledging the convenience of every-two-month injections, some persons receiving LAI ART expressed relief by lifting the emotional stress of taking a daily-pill that reminded them of their HIV positive status. Emerging clinical trial data supports the individual and public health benefits of LAI ART, regardless of prior viral-suppression; our work adds to a growing body of literature demonstrating the potential psychological benefits associated with this novel treatment modality for PWH regardless of recent viral-suppression.
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Affiliation(s)
- Harsh Agarwal
- Department of Global Health and Infectious Diseases, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hanna E Huffstetler
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher Lopez
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Vivian F Go
- Department of Health Behaviour, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire E Farel
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah E Rutstein
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yokota T, Kurosawa S, Yoshimura Y, Bingo M, Yamaguchi T, Takada Y, So Y, Miyata N, Nakayama H, Sakurai A, Sato K, Ito C, Aisa Y, Nakazato T. Pioneering cord blood transplantation in relapsed/refractory HIV-related lymphoma: A case study with concurrent intramuscular antiretroviral therapy. Int J Infect Dis 2024:107124. [PMID: 38838848 DOI: 10.1016/j.ijid.2024.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
A 44-year-old HIV-positive man diagnosed with diffuse large B-cell lymphoma in 2021 achieved complete remission with six cycles of R-CHOP therapy but had a relapse in November 2022. ESHAP therapy failed to induce remission, leading to complete remission with four cycles of Pola-BR therapy. Post-failure of autologous stem cell harvest, cord blood transplantation (CBT) was performed in June 2023. Notably, this case used recently approved intramuscular antiretroviral therapy (ART) with cabotegravir and rilpivirine, addressing gastrointestinal complications during CBT. This innovative use of intramuscular ART in the treatment of malignancy represents a first in the field, offering a pioneering approach to HIV-related lymphoma.
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Affiliation(s)
- Takako Yokota
- Department of Hematology, Yokohama Municipal Citizen's Hospital
| | - Shuhei Kurosawa
- Department of Hematology, Yokohama Municipal Citizen's Hospital.
| | | | - Masato Bingo
- Department of Laboratory Medicine, Tokyo Medical University Hospital
| | - Tomoko Yamaguchi
- Department of Laboratory Medicine, Tokyo Medical University Hospital
| | - Yusuke Takada
- Department of Hematology, Yokohama Municipal Citizen's Hospital
| | - Yuna So
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital
| | - Nobuyuki Miyata
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital
| | - Hitomi Nakayama
- Department of Hematology, Yokohama Municipal Citizen's Hospital
| | - Aki Sakurai
- Department of Hematology, Yokohama Municipal Citizen's Hospital
| | - Kosuke Sato
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital
| | - Chisako Ito
- Department of Hematology, Yokohama Municipal Citizen's Hospital
| | - Yoshinobu Aisa
- Department of Hematology, Yokohama Municipal Citizen's Hospital
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Liu J, Yan Y, Li Y, Lin K, Xie Y, Tan Z, Liu Q, Li J, Wang L, Zhou Y, Yao G, Huang S, Ye C, Cen M, Liao X, Xu L, Zhang C, Yan Y, Huang L, Yang F, Yang Y, Fu X, Jiang H. Factors associated with antiretroviral treatment adherence among people living with HIV in Guangdong Province, China: a cross sectional analysis. BMC Public Health 2024; 24:1358. [PMID: 38769474 PMCID: PMC11106959 DOI: 10.1186/s12889-024-18774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living with HIV (PLHIV) in the "test and treat" era. Multiple psychosocial factors tend to coexist and have a syndemic effect on ART adherence. We aimed to explore factors associated with ART adherence and the syndemic effect of multiple psychosocial factors on ART adherence among PLHIV newly starting ART in Guangdong Province, China. METHODS Newly diagnosed PLHIV from six cities in Guangdong Province were recruited between May 2018 and June 2019, and then followed up from May 2019 to August 2020. Baseline and follow-up data were collected from a questionnaire and the national HIV surveillance system, the follow-up data of which were analyzed in this study. A Center for Adherence Support Evaluation (CASE) index > 10 points was defined as optimal ART adherence, which was measured via participants' self-reported adherence during follow-up survey. Multivariable logistic regression was used to identify factors associated with ART adherence. Exploratory factor analysis (EFA) and multi-order latent variable structural equation modeling (SEM) were performed to explore the syndemic effect of multiple psychosocial factors on ART adherence. RESULTS A total of 734 (68.53%) follow-up participants were finally included in this study among the 1071 baseline participants, of whom 91.28% (670/734) had self-reported optimal ART adherence. Unemployment (aOR = 1.75, 95%CI: 1.01-3.02), no medication reminder (aOR = 2.28, 95%CI: 1.09-4.74), low medication self-efficacy (aOR = 2.28, 95%CI: 1.27-4.10), low social cohesion (aOR = 1.82, 95%CI: 1.03-3.19), no social participation (aOR = 5.65, 95%CI: 1.71-18.63), and ART side effects (aOR = 0.46, 95%CI: 0.26-0.81) were barriers to optimal ART adherence. The EFA and second-order latent variable SEM showed a linear relationship (standardized coefficient = 0.43, P < 0.001) between ART adherence and the latent psychosocial (syndemic) factor, which consisted of the three latent factors of medication beliefs and self-efficacy (standardized coefficient = 0.65, P < 0.001), supportive environment (standardized coefficient = 0.50, P < 0.001), and negative emotions (standardized coefficient=-0.38, P < 0.01). The latent factors of medication beliefs and self-efficacy, supportive environment, and negative emotions explained 42.3%, 25.3%, and 14.1% of the variance in the latent psychosocial factor, respectively. CONCLUSIONS About nine out of ten PLHIV on ART in Guangdong Province self-reported optimal ART adherence. However, more efforts should be made to address barriers to optimal ART adherence.
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Affiliation(s)
- Jun Liu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Yao Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yan Li
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Kaihao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Yingqian Xie
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Qicai Liu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lihua Wang
- Jiangmen Center for Disease Control and Prevention, Jiangmen, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Gang Yao
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Chenglong Ye
- Yangjiang Center for Disease Control and Prevention, Yangjiang, China
| | - Meixi Cen
- Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Xiaowen Liao
- Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Lu Xu
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Chi Zhang
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Yubin Yan
- Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Lin Huang
- Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Fang Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Xiaobing Fu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China.
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China.
- Institute for Global Health, University College London, London, NW3 2PF, United Kingdom.
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Raccagni AR, Galli L, Lucente MF, Candela C, Lolatto R, Trentacapilli B, Ponta G, Messina E, Gianotti N, Castagna A, Nozza S. High Propensity to Switch to Long-acting Injectable HIV PrEP with Cabotegravir in a Cohort of Oral PrEP Experienced Men who Have Sex with Men in Italy. AIDS Behav 2024; 28:907-911. [PMID: 37792228 DOI: 10.1007/s10461-023-04197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Abstract
Aim was to investigate the propensity to switch to long-acting injectable HIV pre-exposure prophylaxis (PrEP) with cabotegravir among oral PrEP-experienced men who have sex with men. Out of 377 PrEP users, 325 (86.2%) were interested (would like = 210) or considering (would consider = 115) switch to long-acting PrEP. At multivariable analysis, the odds ratio of interest in long-acting PrEP in non-adherent vs. adherent individuals to oral PrEP was 5.03 (95%CI = 1.73-14.61,p = 0.003) and of consideration 1.63 (95%CI = 0.51-5.23,p = 0.410). We observed very high propensity to switch to long-acting PrEP, particularly among non-adherent users. Rapid availability of long-acting PrEP might address unmet needs of PrEP users in Italy.
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Affiliation(s)
| | - Laura Galli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Caterina Candela
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giacomo Ponta
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
| | - Emanuela Messina
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Via Stamira D'Ancona 20, Milano, 20127, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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Ripamonti D, Rusconi S, Zazzi M. A cautionary note on entry and exit strategies with long-acting cabotegravir and rilpivirine. AIDS 2024; 38:263-265. [PMID: 38116723 DOI: 10.1097/qad.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital and DIBIC 'Luigi, Sacco', University of Milan, Milan
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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O’Shea JG, Cholli P, Heil EL, Buchacz K. Considerations for long-acting antiretroviral therapy in older persons with HIV. AIDS 2023; 37:2271-2286. [PMID: 37965737 PMCID: PMC10993170 DOI: 10.1097/qad.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.
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Affiliation(s)
- Jesse G. O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preetam Cholli
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily L. Heil
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Rodriguez Gonzalez H, Volcan AI, Castonguay BJU, Carda-Auten J, Ruiz C, Peretti M, Suarez A, Kerrigan D, Wohl DA, Barrington C. "What Is the Benefit?": Perceptions and Preferences for Long-Acting Injectable Antiretroviral Therapy Among People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:467-483. [PMID: 38096455 PMCID: PMC10785827 DOI: 10.1521/aeap.2023.35.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Long-acting injectable antiretroviral therapy (LA-ART) expands treatment options for people living with HIV (PLWH). This qualitative study characterizes LA-ART awareness, perceptions, and preferences among PLWH engaged in HIV care. From 2019 through 2021, we conducted semistructured in-depth interviews with 71 PLWH sampled from three clinics in three U.S. settings (North Carolina, Washington, DC, Massachusetts). Transcripts were analyzed using narrative and thematic techniques. Participant mean age was 46 years (range 24-72); most were cisgender men (55%) and virally suppressed (73%). Most participants had not heard of LA-ART and reacted with a mix of excitement and cautiousness. Potential LA-ART benefits included easier adherence, privacy, and effectiveness; concerns included effectiveness, side effects, costs, and increased clinic visits. Participants appreciated that LA-ART could support achieving and sustaining viral suppression. To inform their decision, participants wanted more information and convenient access and administration. Findings indicated that a shared decision-making approach and economic and logistical support for PLWH could facilitate LA-ART uptake.
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Affiliation(s)
- Humberto Rodriguez Gonzalez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Andrea Isabel Volcan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Breana Jae Uhrig Castonguay
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Jessica Carda-Auten
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Carolina Ruiz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Matteo Peretti
- Fenway Institute at Fenway Health, Boston, Massachusetts
| | - Angela Suarez
- Program Integration and Evaluation, La Clinica Del Pueblo, Washington, D.C
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - David Alain Wohl
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
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9
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Goebel MC, Guajardo E, Giordano TP, Patel SM. The New Era of Long-Acting Antiretroviral Therapy: When and Why to Make the Switch. Curr HIV/AIDS Rep 2023; 20:271-285. [PMID: 37733184 DOI: 10.1007/s11904-023-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Despite the availability of safe and effective oral combination antiretroviral therapy, barriers to maintaining viral suppression remain a challenge to ending the HIV epidemic. Long-acting injectable antiretroviral therapy was developed as an alternative to daily oral therapy. This review summarizes the current literature on the efficacy of long-acting cabotegravir plus rilpivirine for the treatment of HIV-1, reasons to switch to injectable therapy, and barriers to switching. RECENT FINDINGS Long-acting cabotegravir plus rilpivirine is safe and effective in maintaining HIV-1 virologic suppression. Ideal candidates for switching to long-acting cabotegravir plus rilpivirine are virologically suppressed on oral regimens with good adherence and no history of virologic failure or baseline resistance. Indications to switch to injectable therapy include patient preference, the potential for improved adherence, and avoidance of adverse effects. Implementation research is needed to assess and overcome system barriers. Long-acting cabotegravir plus rilpivirine is a novel alternative to oral antiretrovirals, with the potential to improve adherence and quality of life in people with HIV.
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Affiliation(s)
- Melanie C Goebel
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA.
| | - Emmanuel Guajardo
- Section of Infectious Diseases, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA
| | - Thomas P Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center Houston, TX, USA
| | - Shital M Patel
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA
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10
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Emmert M, Rohrbacher S, Jahn J, Fernando K, Lauerer M. Preferences of People Living with HIV for Long-Acting Antiretroviral Treatment in Germany: Evidence from a Discrete Choice Experiment. THE PATIENT 2023; 16:537-553. [PMID: 37436659 PMCID: PMC10409836 DOI: 10.1007/s40271-023-00641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This study aimed to elicit preferences for attributes of current and novel long-acting antiretroviral therapy for human immunodeficiency virus treatment. METHODS Primary survey data were collected (July-October 2022) on a sample of 333 people living with human immunodeficiency virus in Germany from a patient recruitment agency. Respondents were invited by e-mail to respond to a web-based questionnaire. After performing a systematic literature review, we conducted qualitative semi-structured interviews to identify and select the key attributes of drug therapy for patients' preferences for human immunodeficiency virus treatment. Based on this, a discrete choice experiment survey elicited preferences for long-acting antiretroviral therapy characteristics, including the type of medication, frequency of dosing, the location of treatment, the risk of both short-term and long-term side effects, as well as possible interactions with other medications or (party) drugs. A statistical data analysis was performed using multinomial logit models. An additional latent class multinomial logit was performed to evaluate subgroup differences. RESULTS Overall, 226 respondents (86% male, mean age 46.1 years) were included in the analysis. The frequency of dosing (36.1%) and the risk of long-term side effects (28.2%) had the greatest influence on preferences. The latent class analysis identified two patient groups. While the first class (n = 135; 87% male, mean age 44.4 years) found the frequency of dosing (44.1%) to be most important, the second class (n = 91; 85% male, mean age 48.6 years) focused on the risk of long-term side effects (50.3%). The evaluation of structural variables showed that male respondents, those living in small cities or villages, and those with better health status results were significantly more likely to be assigned to the second class (p < 0.05 each). CONCLUSIONS All attributes included in our survey were important to participants when choosing an antiretroviral therapy. We found evidence that the frequency of dosing as well as the risk of long-term side effects have a particular impact on the acceptance of novel therapy regimens and should be considered in order to optimize adherence and satisfaction.
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Affiliation(s)
- Martin Emmert
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany.
| | - Stefan Rohrbacher
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
| | - Jennifer Jahn
- GWS-Gesundheit Wissenschaft Strategie GmbH (Health-Science-Strategy Ltd.), Bayreuth, Germany
| | - Katharina Fernando
- GWS-Gesundheit Wissenschaft Strategie GmbH (Health-Science-Strategy Ltd.), Bayreuth, Germany
| | - Michael Lauerer
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
- GWS-Gesundheit Wissenschaft Strategie GmbH (Health-Science-Strategy Ltd.), Bayreuth, Germany
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11
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Masich AM, Gomes D, Higginson RT, Morgan Z, Nixon D, Tran M, Winthrop E, Fulco PP. HIV virologic response and baseline genotypic resistance in a long-acting cabotegravir/rilpivirine initiation program. AIDS 2023; 37:1641-1642. [PMID: 37450631 DOI: 10.1097/qad.0000000000003590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Anne M Masich
- Virginia Commonwealth University School of Pharmacy
- Department of Pharmacy
| | - Denese Gomes
- Division of Infectious Diseases, Virginia Commonwealth University Health System
| | - Robert T Higginson
- Division of Infectious Diseases, Virginia Commonwealth University Health System
| | - Zara Morgan
- Division of Infectious Diseases, Virginia Commonwealth University Health System
| | - Daniel Nixon
- Division of Infectious Diseases, Virginia Commonwealth University Health System
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Melissa Tran
- Division of Infectious Diseases, Virginia Commonwealth University Health System
| | - Elizabeth Winthrop
- Division of Infectious Diseases, Virginia Commonwealth University Health System
| | - Patricia P Fulco
- Department of Pharmacy
- Division of Infectious Diseases, Virginia Commonwealth University Health System
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12
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Yu F, Hsiao YH, Park S, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia. AIDS Behav 2023; 27:1287-1303. [PMID: 36348191 PMCID: PMC10036452 DOI: 10.1007/s10461-022-03865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.
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Affiliation(s)
- Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | | | | | - Keita Kambara
- Japanese Network of People living with HIV/AIDS, Tokyo, Japan
| | - Brent Allan
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
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13
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Matza LS, Howell TA, Chounta V, van de Velde N. Patient preferences and health state utilities associated with the treatment process of antiretroviral therapy for people living with HIV. Qual Life Res 2023; 32:531-541. [PMID: 36512302 PMCID: PMC9746581 DOI: 10.1007/s11136-022-03290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE People living with HIV (PLHIV) have reported challenges associated with daily oral antiretroviral therapy (ART), including missed doses, negative psychological impact, and difficulty remaining discreet while at home or traveling. Recently approved long-acting injectable (LAI) ART may help eliminate these concerns. The purpose of this study was to examine patient preferences and estimate health state utilities associated with oral and LAI treatment for ART. METHODS Four health state vignettes were developed based on published literature, clinician interviews, and a pilot study. All vignettes included the same description of HIV, but differed in treatment regimens: (A) single daily oral tablet, (B) two daily oral tablets, (C) injections once monthly, and (D) injections every two months. PLHIV in the UK reported their preferences and valued the health states in time trade-off utility interviews. RESULTS The sample included 201 PLHIV (83.1% male; mean age = 44.9y). The health states frequently selected as most preferable were D (n = 119; 59.2%) and A (n = 75; 37.3%). Utility differences among health states were relatively small, which is typical for treatment process utilities (mean utilities: A, 0.908; B, 0.905; C, 0.900; D, 0.910). Statistically significant differences in utility were found for one vs. two tablets and injections every month vs. every two months (p < 0.001). Participants' quotations highlight the wide range of reasons for treatment process preferences. CONCLUSIONS Current results indicate that many PLHIV would prefer LAI ART. The reported utilities may be useful in economic modeling comparing oral vs. LAI ART.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA.
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14
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van Dyk R, Lammertink B, Appiah A, Plieger H, de los Rios P, Okoli C. Preference for non-daily ART is associated with perceived
extent of ART-related emotional, psychosocial, physical, and
adherence challenges among people living with HIV in the
Netherlands and other European countries. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/156768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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15
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Collins LF, Corbin-Johnson D, Asrat M, Morton ZP, Dance K, Condra A, Jenkins K, Todd-Turner M, Sumitani J, Smith BL, Armstrong WS, Colasanti JA. Early Experience Implementing Long-acting Injectable Cabotegravir/Rilpivirine for HIV-1 Treatment at a Ryan White-funded Clinic in the U.S. South. Open Forum Infect Dis 2022; 9:ofac455. [PMID: 36147599 PMCID: PMC9487705 DOI: 10.1093/ofid/ofac455] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
Background Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to improve medication adherence, reduce human immunodeficiency virus (HIV) stigma, and promote equity in care outcomes among people with HIV (PWH). We describe our early experience implementing LAI-cabotegravir/rilpivirine (CAB/RPV) for maintenance HIV-1 treatment. Methods We launched a pilot LAI-ART program at a large Ryan White-funded clinic in the Southeast, which accept provider-initiated referrals from April 14, 2021 to December 1, 2021. Our interdisciplinary program team (Clinician-Pharmacy-Nursing) verified clinical eligibility and pursued medication access for eligible patients. We describe (1) demographic and clinical variables of PWH referred and enrolled and (2) early outcomes among those accessing LAI-CAB/RPV. Results Among 58 referrals, characteristics were median age 39 (Q1–Q3, 30.25–50) years, 74% male, and 81% Black, and payor source distribution was 26% Private, 21% Medicare, 19% Medicaid, and 34% AIDS Drugs Assistance Program. Forty-five patients (78%) met clinical eligibility for LAI-CAB/RPV; ineligibility concerns included evidence of confirmed or possible RPV resistance (n = 8), HIV nonsuppression (n = 3), possible RPV hypersensitivity (n = 1), and pregnancy (n = 1). Among 45 eligible PWH, 39 (87%) enrolled and 15 (38%) initiated LAI-CAB/RPV after a median of 47 (Q1–Q3, 31–95) days since enrollment. Conclusions Implementing LAI-ART at a Southern US Ryan White-funded clinic has been challenged by the following: substantial human resource capital to attain drug, administer injections, and support enrolled patients; delayed therapy initiation due to insurance denials; patient ineligibility primarily due to possible RPV resistance; and inability to provide drug regardless of payor source. These barriers may perpetuate disparities in ART access and outcomes among PWH and should be urgently addressed so that LAI-ART can be offered equitably.
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Affiliation(s)
- Lauren F Collins
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | | | - Meron Asrat
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Zoey P Morton
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Kaylin Dance
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Alton Condra
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Kimberly Jenkins
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Marie Todd-Turner
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Jeri Sumitani
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Bradley L Smith
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Wendy S Armstrong
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Jonathan A Colasanti
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health , Atlanta, GA , USA
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16
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Okoli C, Finkielsztejn L, Appiah A, Pugliese P, Fructuoso C, de los Rios P. Comorbidities, comedications and polypharmacy among people living with HIV and associated challenges with HIV antiretroviral therapy: Findings from people living with HIV in four countries in Western Europe. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/151521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Taki E, Soleimani F, Asadi A, Ghahramanpour H, Namvar A, Heidary M. Cabenuva: the last FDA-approved drug to treat HIV. Expert Rev Anti Infect Ther 2022; 20:1135-1147. [PMID: 35596583 DOI: 10.1080/14787210.2022.2081153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The conventional combination antiretroviral therapy (cART) besides all its benefits, exhibited poor adherence to daily pill administration, life-long treatment period and emergence of viral resistance. The development of long-acting (LA) drugs have changed the management of common medical conditions for human immunodeficiency virus (HIV). Cabenuva is the first LA antiretroviral injectable drug composed of nano-formulation of cabotegravir (CAB) and rilpivirine (RPV). AREAS COVERED In this review article, we aim to have a brief overview of results of major clinical trials which administrated cabenuva for patients considering the efficacy and safety profiles. Moreover, we discuss about CAB and RPV chemical structure, mechanism of action, activity against drug-sensitive and resistant HIV and pharmacodynamics/ pharmacokinetics properties. EXPERT OPINION Based on the results of the ATLAS and FLAIR trials, cabenuva regimen once-monthly has shown equal effectivity to oral cART in maintaining HIV-1 suppression in patients. Furthermore, ATLAS-2M study revealed the non-inferiority of cabenuva regimen every 8 weeks compared to every 4 weeks. The injectable LA ART, reduces the number of treatment intake as well as increases adherence especially in patients with HIV-related stigma. Administration of extended-release agents probably minimize the risk of treatment-related toxicity and resistance related to sub-optimal adherence to oral ART, so cabenuva can be suggested as a suitable alternative for HIV infection control in current era.
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Affiliation(s)
- Elahe Taki
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Soleimani
- Department of Chemistry, Medicinal Chemistry Research Laboratory, Shiraz University of Technology, Shiraz, Iran
| | - Arezoo Asadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahramanpour
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Namvar
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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18
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Koga I, Wakatabe R, Okamoto N, Sasai A, Kambara K, Maldonado A, de Los Rios P, Okoli C. Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics. AIDS Behav 2022; 26:1633-1651. [PMID: 34870772 PMCID: PMC8647062 DOI: 10.1007/s10461-021-03515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
We examined satisfaction and perceived challenges with antiretroviral therapy (ART) among people living with HIV (PLHIV) in Japan vs three other Asian countries (China, Taiwan, South Korea), and 21 non-Asian countries, using data from the 2019 Positive Perspectives Study (pooled sample size from all 25 countries = 2389). Participants in other Asian countries were more likely than those in Japan to report they missed ART ≥ 1 time in the past month because they were depressed/overwhelmed (57.4%[89/155] vs 32.0%[24/75]), had privacy concerns (56.8%[88/155] vs 30.7%[23/75]), were concerned about the potential long-term negative impacts of ART (46.5%[72/155] vs 26.7%[20/75]), or just wanted to forget about HIV (45.8%[71/155] vs 22.7%[17/75]). ART satisfaction however did not differ significantly between surveyed PLHIV in Japan (54.7%[41/75]) vs those in other Asian countries (47.7%[74/155]). The percentage who felt that daily ART dosing limited their lives was 36.0%[27/75] among participants from Japan, 48.4%[75/155] among participants from other Asian countries, and 27.3%[589/2159] among those from non-Asian countries. Within a structural equation model using pooled data from all 25 countries, positive correlations were seen between ART satisfaction and "provider engagement" (β = 0.35), high perceived control over ART dosing schedule (β = 0.28), and the belief that ART prevents HIV transmission (β = 0.16). Conversely, negative correlations were seen between ART satisfaction and experience of ART side-effects (β = - 0.24), high "ART anxiety" (β = - 0.20); and being on multi-tablet regimens (β = - 0.13). Those ART-satisfied reported higher self-rated health and greater ART adherence. These findings underscore the need for patient-centered care to enhance treatment satisfaction and improve ART adherence.
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Affiliation(s)
| | | | | | | | - Keita Kambara
- Japanese Network of People Living With HIV/AIDS (JANP Plus), Tokyo, Japan
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Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review. Curr Opin HIV AIDS 2022; 17:145-161. [PMID: 35439789 DOI: 10.1097/coh.0000000000000734] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it. RECENT FINDINGS According to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues. SUMMARY Knowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.
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Initiation of long-acting cabotegravir plus rilpivirine as direct-to-injection or with an oral lead-in in adults with HIV-1 infection: week 124 results of the open-label phase 3 FLAIR study. Lancet HIV 2021; 8:e668-e678. [PMID: 34656207 DOI: 10.1016/s2352-3018(21)00184-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous work established non-inferiority of switching participants who were virologically suppressed from daily oral standard of care to monthly long-acting intramuscular injections of cabotegravir plus rilpivirine over 96 weeks following a cabotegravir plus rilpivirine oral lead-in. Here, we report an evaluation of switching participants from standard of care oral regimens to long-acting cabotegravir plus rilpivirine via direct-to-injection or oral lead-in pathways. METHODS This study reports the week 124 results of the FLAIR study, an ongoing phase 3, randomised, open-label, multicentre (11 countries) trial. Antiretroviral therapy (ART)-naive participants who were virologically suppressed (HIV-1 RNA <50 copies per mL) during the 20-week induction phase with standard of care were randomly assigned (1:1) to continue the standard of care oral regimen or switch to long-acting cabotegravir plus rilpivirine (283 per group) in the 100-week maintenance phase. Randomisation was stratified by sex at birth and baseline (pre-induction) HIV-1 RNA (<100 000 or ≥100 000 copies per mL). Participants randomly assigned to long-acting therapy at baseline received a cabotegravir (30 mg) plus rilpivirine (25 mg) once daily oral lead-in for at least 4 weeks before first injection and could choose to continue long-acting cabotegravir (400 mg) plus rilpivirine (600 mg) every 4 weeks from week 100 or withdraw. At week 100, participants in the oral comparator ART group, in discussion with the investigator, could elect to switch to long-acting therapy (extension switch population), either direct-to-injection or with a 4 week oral lead-in (oral lead-in group), or withdraw. Week 124 endpoints included plasma HIV-1 RNA 50 or more copies per mL and less than 50 copies per mL (US Food and Drug Administration [FDA] Snapshot), confirmed virological failure (two consecutive HIV-1 RNA ≥200 copies per mL), and safety and tolerability. The study is registered at ClinicalTrials.gov, NCT02938520. FINDINGS Screening occurred between Oct 27, 2016, and March 24, 2017. At week 100, 232 (92%) of 253 participants transitioned to long-acting cabotegravir plus rilpivirine in the extension phase (111 [48%] in the direct-to-injection group and 121 [52%] in the oral lead-in group; extension switch population). 243 (86%) of the 283 who were randomly assigned to the long-acting therapy group continued the long-acting regimen into the extension phase. One (<1%) participant in each extension switch group had 50 or more HIV-1 RNA copies per mL; 110 (99%) participants in the direct-to-injection group and 113 (93%) participants in the oral lead-in group remained suppressed (HIV-1 RNA <50 copies per mL) at the week 124 Snapshot. The lower suppression rates in the oral lead-in group were driven by non-virological reasons. For participants in the randomly assigned long-acting group, 227 (80%) of 283 participants remained suppressed; at the week 124 Snapshot, 14 (5%) participants had HIV-1 RNA 50 or more copies per mL, including five additional participants since the week 96 analysis. The remaining 42 (15%) participants in the randomly assigned long-acting group had no virological data. Adverse events leading to withdrawal were infrequent, occurring in three (1%) participants in the extension switch population (one in the direct-to-injection group and two in the oral lead-in group) after 24 weeks of cabotegravir plus rilpivirine therapy, and 15 (5%) participants in the randomly assigned long-acting group up to 124 weeks of therapy. No deaths occurred in the extension phase. Overall, cabotegravir plus rilpivirine adverse event type, severity, and frequency were similar across all groups. Injection site reactions were the most common adverse event, occurring after 914 (21%) of 4442 injections in the extension switch population and 3732 (21%) of 17 392 injections in the randomly assigned long-acting group. Injection site reactions were mostly classified as mild-to-moderate in severity and decreased in incidence over time. Four (2%) of 232 participants in the extension switch population and seven (2%) of 283 in the randomly assigned long-acting group withdrew due to injection-related reasons. INTERPRETATION After 24 weeks of follow-up, switching to long-acting treatment with or without an oral lead-in phase had similar safety, tolerability, and efficacy, supporting future evaluation of the simpler direct-to-injection approach. The week 124 results for participants randomly assigned originally to the long-acting therapy show long-acting cabotegravir plus rilpivirine remains a durable maintenance therapy with a favourable safety profile. FUNDING ViiV Healthcare and Janssen Research & Development.
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