AIDS: anti-HIV injection as a new opportunity

Highly effective antiretroviral drugs or combinations of active ingredients have been available since the mid-1990s. But they have to be taken orally every day to best keep the HIV viral load in the body below the detection limit and thus prevent damage to the immune system. This is a challenge – not only in many poorer regions of the world with fragile health systems.

Easier intake of effective AIDS medication could improve both the logistics of care for those affected and their adherence to therapy. In this context, there has recently been a potentially significant innovation: On October 16, a committee of experts from the European Medicines Agency (EMA) recommended the marketing authorization of two injectable HIV preparations. The active ingredients are the reverse transcriptase inhibitor (NNRTI) rilpivirine and a new so-called integrase inhibitor (cabotegravir). Reverse transcriptase blockers inhibit the transcription of the RNA genetic material in infected cells into DNA, while integrase inhibitors block the subsequent step of incorporating the DNA into the cell nucleus. Both are intended to suppress virus replication.

Injections every two months

The main advantage of the new therapy concept lies in the long effectiveness of the drugs in combination. “Both drugs are injected intramuscularly monthly or every two months. Together they form a new, long-lasting antiretroviral therapy, ”it said in the German Pharmaceutical Newspaper.

In the treatment of an HIV infection, the drugs could represent a further step towards reliable long-term suppression of the AIDS pathogen. “The combination of the two preparations is intended for the maintenance therapy of adults who, with their current antiretroviral treatment, have undetectable levels of HIV in the blood (viral load less than 50 copies / milliliter blood; note) and in whom the virus is not against NNRTI or integrase -Hemmer resistant. “, Wrote the German pharmacist newspaper. The long-term suppression of the viral load also means that no further infections with HIV can occur.

Also works preventively

The therapy is only one point. Cabotegravir could also be a more effective option for drug prophylaxis of new infections with the AIDS pathogen. The results of a clinical study with 3,200 women between the ages of 18 and 45 in Botswana, Kenya, Malawi, South Africa, Uganda and Zimbabwe were only recently published. The daily intake of oral medication to prevent HIV infection was compared to an injection of cabotegravir every two months.

The results were hailed as a great success by UNAIDS: “The study shows that long-acting injections to prevent HIV in women in southern Africa were 89 percent more effective than daily tablet intake”, wrote the organization.

Could be a game changer

The scientific investigation was broken off prematurely because of the great success that was emerging. In the group of women who had taken prophylaxis in tablet form, 34 infections with HIV had been registered. In the comparison group with the injectable drug, there were only four cases.

“These results are of the utmost importance. UNAIDS has long called for additional, accepted and effective ways of HIV prevention. This could be a game changer, ”said UNAIDS Director General Winnie Byanyima. “If donors and governments invested now in ensuring access to injectable prophylaxis for women at higher risk for HIV infection, the number of new infections could be dramatically reduced.”

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