Optimizing Outcomes in HIV Treatment - Episode 15

Investigational HIV Drugs and Injectable Formulations

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The HCPLive Peer Exchange: Optimizing Outcomes in HIV Treatment features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of health services at Ursinus College, also in Collegeville, PA.

The panelists are:

  • Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
  • Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
  • Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

In this segment of the Peer Exchange, the panelists discuss some investigational HIV agents that are available in injectable forms.

“One of the more exciting integrase inhibitors is something called cabotegravir,” says Sax, which is being developed in both oral and injectable formulations. The injectable formulations is very long-acting, he says, “So the theory is you can give it once a month for treatment or once every three months for prevention, and that’s being studied right now.”

Another agent that is being developed as an injectable formulation is rilpivirine. Sax says, “Rilpivirine alone among the non-nucleoside reverse transcriptase inhibitors has not been associated with severe skin hypersensitivity reactions.”

Frank believes that the availability of long-acting injectable medications is beneficial. A study that used an induction strategy followed by maintenance with cabotegravir and rilpivirine, although not in their long-acting forms, forms “the basis of a start and switch clinical trial that is going to be moving forward where we may be studying these long-acting agents as a two-drug combination in individuals as a maintenance regimen.”

A once-monthly injectable regimen may lead to partnering between specialists and primary care physicians. If given a choice of a daily pill or a monthly injection, Sax say, “a significant proportion of them, not a half but I’d say a significant minority, choose the injection,” and so specialists may be asking primary care physicians to carry out this administration regimen in the clinic.