Despite the remarkable advances in treatment, people with HIV still face considerable social stigma around their status, especially the challenge of taking daily medications.
In a recent survey among people living with HIV, three-fifths said they lived in fear that their HIV status would be shared without their consent and nearly half (45%) had been forced to share their status after someone saw their medication.
From next year, people with HIV in England and Wales will have routine access to a combination injection given every two months which removes the need to take daily oral medication, following a recommendation by the UK health watchdog, the National Institute for Health and Care Excellence (NICE).
The regimen combines Vocabria, a long-acting form of cabotegravir developed by ViiV Healthcare (global specialist HIV company majority owned by GSK), and Rekambys, a long-acting form of rilpivirine developed by Janssen.
Cabotegravir is an integrase inhibitor, while rilpivirine is a non-nucleoside reverse transcriptase inhibitor. The combination has been shown to be highly effective in reducing the viral load of HIV in the body to undetectable levels (usually less than 50 copies of virus per ml of blood).
The two-monthly combination is for adults who are virologically suppressed on a stable antiretroviral regimen without past or present evidence of viral resistance or virological failure with HIV medications.
NICE’s recommendation is the first time an HIV treatment has been appraised and approved by the body, although it follows a positive decision from its sister body in Scotland, the Scottish Medicines Consortium (SMC), in October.
“We still have a long way to go in educating around HIV, but today’s announcement demonstrates how far we’ve come since the 1980s epidemic,” said Garry Brough from patient group Positively UK. “It is a huge step forward in offering people living with HIV in England and Wales greater choice in how they manage their condition.”
Brough added that the decision reflects “the rightful need” for people living with HIV to have “the freedom to manage their HIV in a way that works best for them”.
The drug combination was approved in Europe in December 2020 and was welcomed by Dr Antonio Antela from University Hospital, Santiago de Compostela, Spain. “Daily antiretrovirals have transformed the lives of people living with HIV. However, taking daily medication can pose challenges for some people; it may act as a constant reminder of HIV or be a cause of fear that their HIV status will be disclosed.”
Dr Antela said that the long-acting regimen had been proved to be “as effective as treatment with current daily antiviral therapy” in clinical trials and “could change the treatment experience” for some people living with HIV.