How two-month HIV shots reduce pill burden

A 24-month study in Kenya, Uganda and South Africa has found that injectable HIV treatment, Cabotegravir/Rilpivirine, also known in medical terms as CAB LA + RPV LA, administered every two months, is safe, well-tolerated, and preferred by most HIV patients. Results from the first 12 months offer renewed hope for adherence to HIV antiretroviral management, reduced HIV related deaths, and enhanced overall quality of life for people living with HIV. Dubbed Impala (Improving HIV-1 Control in Africa with Long-Acting Antiretrovirals), the study, a randomised controlled trial, concluded in October and study team is currently cleaning the complete data. Despite major strides in treatment, the global HIV response remains shaky. World Health Organisation (WHO) estimates that in 2024, 40.8 million people were living with HIV, 1.3 million acquired HIV, and 630,000 died from HIV-related illnesses. Currently, HIV treatment involves taking a daily pill that combines three or four medicines that work together to control the virus. This combination includes Dolutegravir (DTG), which WHO recommended in 2016 because it has fewer side effects, fewer drug interactions, and a high barrier to resistance. While this once-a-day pill revolutionised treatment and remains Kenya's first-line regimen, daily adherence remains a persistent challenge for many people, particularly among adolescents, young adults, and marginalised populations. These challenges lead to increased hospitalisations, higher healthcare costs, and contributed to the 680,000 HIV-related deaths recorded in 2022. The Joint United Nations Programme on HIV/Aids (UNAIDS) has set 95-95-95 targets by 2030: 95 per cent of people who have HIV should be diagnosed, 95 per cent of people who have HIV should be on treatment, and 95 per cent of people who have HIV and are on treatment should be virally suppressed. However, at the end of December 2021, just 71 per cent of people living with HIV globally were diagnosed, on treatment, and virally suppressed-far below the target. Simpler option To close this gap, researchers have been exploring simpler, more flexible treatment options, and the long-acting injectable - given once every two months - medication has been found to be among the most promising. The medicine is specially formulated to be released from the injection site slowly: giving a steady, continuous dose over weeks as opposed to the daily oral pill. The Impala study focused on adults whose viral load had remained unsuppressed for two years despite previous antiretroviral therapy (ART)-suggesting a history of adherence challenges. The goal was to assess whether the injectable HIV treatment CAB LA + RPV LA could work for this group in sub-Saharan Africa. According to the findings, the injectable HIV treatment was non-inferior to standard oral regimen-dolutegravir-based therapy (TLD) in African patients who had previously struggled with adherence. In other words, the injectables worked at least as well as the daily oral medication, while reducing the daily medication burden. Dr. Loice Ombajo, an infectious disease specialist, co-director at the Center for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi, and the study's principal investigator for Kenya emphasized the significance: "Many HIV patients in Africa struggle with taking multiple drugs, stigma, and side effects, which can make it difficult to stay on treatment and may eventually lead to resistance and treatment failure. Injectable therapy offers a promising solution-by reducing the burden of daily pills, adherence becomes easier, hence improving quality of life, and helps prevent HIV-related deaths. "These results show that transformation is not only possible-it's within reach. Long-acting injectables help people living with HIV lead longer, healthier lives. This year's World AIDS Day theme, 'Overcoming disruption, transforming the AIDS response', calls on all of us to stay focused on the goal. Studies like IMPALA demonstrate how innovation can re-energize the HIV response, ensuring that no one is left behind," she concluded. Impala was executed by Medical Research Council and the Uganda Virus Research Institute. The study is sponsored by the London School of Hygiene & Tropical Medicine.

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