Today, the entire focus of global healthcare and the scientific community is on developing a novel vaccine or repurposing the already existing drugs to combat the global pandemic Covid-19 caused by novel coronavirus SARS-CoV-2. But still, human immunodeficiency virus (HIV), the causative agent of AIDS, is forging ahead as a crucial global public health concern as it has killed more than approximately 32 million people across the globe. HIV infection is now a controllable health condition which can be achieved by proper prevention, diagnosis, treatment, and care. The appropriate management of HIV allows infected people to live a healthy and long life with the infection.
Prevention is always better than a cure, the current Covid-19 age has proven it well. Coming to HIV, one strategy being adopted to prevent being infected with the virus is the pre-exposure prophylaxis (PrEP) strategy. The PrEP strategy means taking drugs to resist the disease before actually getting the infection. In, 2012 U.S. FDA approved a daily pill of a combination drug to disable the virus. Currently, Truvada or Descovy is the only FDA approved daily oral pill used in HIV PrEP.
For those who do not wish to cling to a daily dose or are not comfortable with daily pills, the application of long-acting drugs could be a great option. Researchers have been working on developing long-acting drugs as a substitute for oral PrEP and hope that the long-acting drug injections could substitute the daily pills in preventing HIV. Long-acting drugs or injections are the drugs that get absorbed in the tissues slowly and exhibit a very slow effect at the initial dosage however; they maintain the drug effect over a longer period. U.S. National Institute of Allergy and Infectious Diseases (NIAID), has sponsored the trial for long-acting drugs that began in December 2016. The trial was named as HPTN 083. The drugs involved in the trial included the main experimental drug cabotegravir for intramuscular injections, Truvada pills, and placebo pills, or placebo injections. Overall 4500 uninfected (HIV-negative), susceptible men and women have participated in the study across the globe. The participants were from various 43 sites across the globe including Argentina, Brazil, Peru, South Africa, Thailand, the United States, and Vietnam.
The enrolled participants were randomly assigned to get cabotegravir injections, Truvada pills, and placebo pills, or placebo injections. The global pandemic COVID-19 has been affected the clinical study resulting in the closing down of 11 study sites. However, an independent data and safety monitoring board (DSMB) reviewed the study trial HPTN 083 in May 2020. The results indicated that long-acting injectable cabotegravir was significantly successful and shown a convincing effect on the study group in preventing HIV. Only 12 individuals out of 50 HIV infected individuals who have participated in the trial were assigned cabotegravir while the remaining 38 were taking a daily dosage of Truvada. The majority of the people who were assigned daily dosage of Truvada were either not taking their daily dose or they forgot to take it. On the other hand, a long-acting dose of cabotegravir proved effective as only 12 of the cabotegravir participant go infected with HIV. The participants who were assigned cabotegravir were injected once every 8 weeks safely and effectively to prevent the infection. Cabotegravir injections lowered the HIV incidences among the men and women assuring an effective and promising alternative to daily pills. The 12 participants despite of taking cabotegravir injections might have got infected due to their physical conditions such as lesser weight. Cabotegravir injections and Truvada pills were considered to be safe and well-tolerated by the participants. Only a few adverse effects such as pain and tenderness at the administration site in the group injected with cabotegravir were found. ViiV Healthcare in a joint venture with GlaxoSmithKline, Pfizer, and Shionogi produced Cabotegravir, while Truvada was produced by Gilead Sciences.
As the data has not yet been published in the journals or presented to the researchers and investigators, DSMB has recommended to NIAID, to announce the study results at the earliest to serve the interest of public health. The other sister study named HPTN 084, includes the same comparison study in heterosexual women, of which results are awaited in November 2020.
According to many researchers, the investigations for innovative prevention therapies should be continued until there is a safe and effective vaccine against HIV in hand. A long-acting injectable drug such as Cabotegravir expected to be a powerful tool in HIV prevention and treatment plan in the future; however, it requires further investigation trials and regulatory approval. Nevertheless, HIV investigators are considering injectable Cabotegravir as a major contributor to eradicating HIV from the planet in the coming years.
References:
- https://www.sciencemag.org/news/2020/05/long-acting-injectable-drug-prevents-hiv-infections
- https://aidsinfo.nih.gov/news/2823/long-acting-injectable-drug-prevents-hiv-among-men-who-have-sex-with-men-and-transgender-women
- https://www.niaid.nih.gov/news-events/long-acting-injectable-drug-prevents-hiv-among-men-who-have-sex-men-and-transgender/
- https://globalhealth.unc.edu/2020/05/landmark-study-finds-long-acting-injectable-drug-prevents-hiv/
- https://www.who.int/news-room/fact-sheets/detail/hiv-aids
