People living with HIV in England and Wales may be eligible for injectable antiretroviral treatment every two months, rather than daily pills.

Two injectable drugs, cabotegravir and rilpivirine, were recommended for use by the UK National Institute for Health and Care (NICE) on Thursday after trials proved they work as effectively as daily tablets, according to their draft guidance. 

To be eligible for cabotegravir with rilpivirine, people must already have a low and stable viral load. 

The Scottish Medicines Consortium has also approved the injections for adults living with HIV in Scotland.

Cabotegravir (also called vocabria), which is made by Viiv Healthcare, and with rilpivirine (also called Rekambys), made by Janssen, are the first long-acting antiretroviral injections available for HIV. 

“Clinical trial results show that cabotegravir with rilpivirine is as effective as oral antiretrovirals at keeping the viral load low,” according to NICE.

“Both cabotegravir and rilpivirine are administered as 2 separate injections every 2 months, after an initial oral (tablet) lead-in period.”

Meindert Boysen, deputy chief executive and director of the Centre for Health Technology Assessment at NICE, said that while  HIV is still incurable, the virus “can be controlled by modern treatment”.

“For some people, having to take daily multi-tablet regimens can be difficult because of drug-related side effects, toxicity, and other psychosocial issues such as stigma or changes in lifestyle,” added Boysen.

“The committee heard that stigma remains an issue for people living with HIV and can have a negative impact on people’s health and relationships,” he added.

“We are pleased therefore to be able to recommend cabotegravir with rilpivirine as a valuable treatment option for people who already have good levels of adherence to daily tablets, but who might prefer an injectable regimen with less frequent dosing,” added Boysen.

Pill fatigue 

“HIV unfortunately remains a stigmatised condition. Although we’re working hard to tackle the stigma surrounding HIV, this new injectable treatment option could help people in house-shares for example who do not wish to share their HIV status and will no longer have to worry about hiding their medication,” said Debbie Laycock, head of policy at HIV charity, Terrence Higgins Trust.

“Pill fatigue is also an issue for some people living with HIV who struggle with the idea of taking antiretroviral drugs every day,” added Laycock.

“Long-acting injectable treatment is also a better option for those who have difficulty swallowing medication. Therefore, the institute’s approval provides a welcome additional treatment option for people living with HIV across England and Wales.”

The United Kingdom has a relevantly small, concentrated HIV epidemic, with an estimated 101,600 people living with HIV in 2017. An estimated 13,000 people will be eligible for the injectable treatment in England

Added Laycock: “This is a great step forward as we work towards ending new cases of HIV by 2030. The institute’s decision brings great potential for HIV prevention including long-lasting pre-exposure prophylaxis (PrEP) in the future.”

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