{"id":7993,"date":"2016-01-18T08:31:47","date_gmt":"2016-01-18T13:31:47","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7993"},"modified":"2016-01-18T08:31:47","modified_gmt":"2016-01-18T13:31:47","slug":"iv-and-injectable-hiv-treatments-are-much-discussed-but-wont-be-here-anytime-soon","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/iv-and-injectable-hiv-treatments-are-much-discussed-but-wont-be-here-anytime-soon\/2016\/01\/18\/","title":{"rendered":"IV and Injectable HIV Treatments Are Much Discussed — But Won’t Be Here Anytime Soon"},"content":{"rendered":"

\"happy<\/a>Something interesting happens when you poll people who treat HIV — and people who have<\/em> HIV — about whether they’d prefer\u00a0a treatment option that consists of a periodic injection or infusion in place of the pill or pills that they take every day.<\/p>\n

Lots<\/em> of them say yes. Even people who are taking just one pill a day, and are having no side effects.<\/p>\n

As a famous comedian (repeatedly) says, What’s the deal\u00a0with that?<\/a><\/em><\/p>\n

Given the success of currently available oral therapies — in which\u00a0essentially 100% of people who take it are virologically suppressed — why do so many people say they want shots instead?<\/p>\n

Part of it, of course, is the way the question is framed, and human nature.\u00a0There’s a tendency to favor the shiney new toy. Here’s a typical headline<\/a> on this topic:<\/p>\n

\"A_Monthly_Shot_Could_Soon_Replace_Daily_HIV_Meds___HIVPlusMag_com\"<\/a><\/p>\n

And the simple question — “Would you prefer a shot over pills?” — implies an optimal available strategy. Let’s imagine a single shot administered quarterly, with a small\u00a0required volume, low rates of injection site reactions, few side effects, and plenty of forgiveness around missed doses. Now we’re talking!<\/p>\n

The reason I bring this up is because a couple of\u00a0recent studies\u00a0show that non-pill treatments for HIV are at the very least feasible.<\/p>\n

Most promisingly, there’s the LATTE-2 study of the\u00a0long-acting antivirals\u00a0cabotegravir and rilpivirine\u00a0— given as injections either every 4 or every 8 weeks — which maintained virologic suppression as well as a standard 3 drug regimen.<\/a> (More details expected soon.)<\/p>\n

And there’s this study of the broadly neutralizing antibody\u00a0VRC01<\/a>, which when infused to patients with viremia, dropped HIV RNA 1.1-1.8 log (10-100 fold) in 6 of 8 with a single infusion. It follows an earlier study<\/a> showing an even more potent antiviral response using a different antibody, 3BNC117. Both treatments dropped HIV RNA long\u00a0after the single dose.<\/p>\n

So we’re on our way, right? Soon we’ll be offering injections or infusions as an alternative to pills, and we’ll all live happily ever after!<\/p>\n

But it’s\u00a0not so simple. Here are a few compelling\u00a0reasons why we’re not going to see\u00a0these injectables as viable treatment options in the near future:<\/p>\n