HIV Cure Medical Breakthrough
In 2018, the University of Nebraska Medical Center had attempted to alter the chemical structure of the then existing antiviral to act on tissues and cells where HIV resides. In early March 2019, a second patient was cured of HIV through stem-cell therapy. Even though the experimental method used has been termed worse, and only suitable for cancer patients, it a sign of the many medical breakthroughs for the cure of virus causing AIDS. The conference held in Seattle in the late March 2019 where the injectable HIV treatment was presented, marked an important phase in curing people living with aids in the United Kingdom and other countries. The highlighted examples are a few of medical attempts to find a long-lasting cure to HIV. However, not all medical attempts have been approved by the FDA or have gone through the clinical trials. Among the few approved medical breakthroughs for the cure of HIV is Long-Acting Injectable Antiretroviral Therapy.Since medical efforts to find medicine for the cure of HIV began, a number of advancements have been made and among them includes antiretroviral drugs (ARV). The ARV breakthrough was a combined effort of the pharmaceutical industry, scientists, advocates, clinicians, and patients. Nevertheless, daily oral antiretroviral was not proved to be fully effective. The scientific evidence has shown that missing ARV doses lead to treatment failure and resistance; hence, hampering the fight against this human life threating epidemic. To find a solution to this HIV medical treatment challenge, the article, Long-Acting, Injectable Antiretroviral Therapy for the Management of HIV Infection: An Update on a Potential Game-Changer” by Mobula, et al. (2016) presents long-acting injectable (LAI) antiretroviral. The injectable treatment is supposed to be formulated on weekly, monthly or several months’ regimens in the bid to replace the oral daily ARV dose both in the rich and poor settings. The article aimed at summarizing the latest advancements in Long-Acting Injectable (LAI) progress as well as review the possibility of LAI revolutionizing HIV management.
Mobula et al. (2016) point key successes in the long-acting injectable despite its incapability to manage chronic diseases in HIV patients. In support of LAIs, the article argued that the use of long-acting injectable antipsychotics in the treatment of schizophrenia has proved effective since it has led to improved adherence, declined hospitalization rates, patient satisfaction, improved patient outcomes, and better quality life. It was also found that the use of glucagon-based LAIs improved the treatment of diabetes. The LAIs were also effective on contraception efforts to reduce unwanted pregnancies. Having seen the benefits of LAIs in the management of various diseases, it is possible to transfer the same medical treatment in the management of HIV.
LAIs have multiple benefits, unlike oral ARVs. For example, the LAIs can be dosed for a specified time compared to the oral ARVs which must be taken daily. In addition, LAI eliminates sides effects such as intestinal reactions and gastrointestinal toxicity associated with the oral dosage. LAI can be formulated to target specific cells such as the ones that require lower doses; this reduces the cost used in the production of ARVs and as well help in catering for the treatment needs of many patients in the resource limiting areas. The LAIs would also be useful in helping critically ill patients, perioperative and hospitalized patients who cannot withstand ARV oral medication. Some patients are at risk of ARV non-adherence, but with LAIs the management of HIV in these populations have been made easier. The healthcare providers who may against the use of ARVs among non-adherence patients efficiently administer LAIs. Despite the LAIs passing the clinical trials, they cannot be used alone without the oral dosage. LAIs takes longer time, perhaps several days, weeks or months for maximum concentration, unlike the oral formulations. As such, the use of LAIs should start with the admission of oral dosage to maintain the required drug concentration before LAIs reaches the maximum concentration. Additionally, the prolonged intervals between long-acting injectable may cause low drug concentrations, and as a result, it may reduce adherence. Even though, the LAIs poses several HIV management challenges, it is the best alternative to the ARVs particularly in the cases where missed dosages are rampant.
Some of Long-acting injectable formulations like non-nucleoside reverse transcriptase inhibitor (NNRTI) and an integrase inhibitor, cabotegravir have passed the clinical development stage and proved effective in the management of HIV. The two formulations are given monthly, and they have been produced through nanomilling technology. The nanomilling technology has been successful in other FDA pharmaceutical approved formulations created for other diseases such as ovarian cancer, cell lung cancer, pancreatic cancer, and breast cancer.
The studies have proved that the use of LAI formulations can also achieve plasma drug concentrations achieved through the use of oral formulations. For example, it is possible for cabotegravir to maintain high levels of plasma consistently for quarterly intramuscular or monthly injections. During the testing of LAI it was observed that for 30 days, a rilpivirine dose of 600-900mg was able to maintain concentrations above the plasma levels. Cabotegravir and Rilpivirine present multiple benefits including its worthiness when used to manage HIV among the patients.
Firstly, Cabotegravir and Rilpivirine are tolerable, especially when they are co-administered. The clinical tests have confirmed that they are well-tolerated and safe for healthy human adults. Secondly, cabotegravir has shown higher resistance barrier compared to rilpivirine, and the resulting mutations resulting from cabotegravir contribute low-level resistance without cross-resistance to other inhibitors. As such, the presence of cabotegravir in LAI protects against the potential rise of high-level resistance. Thirdly, the cost of creating a combination of rilpivirine and cabotegravir have proved affordable. Using the previous estimates production, the two formulations costs approximately $40 per year.Even though the LAI’s have not entirely become the main treatment approach for HIV, it stands out as one of the breakthroughs in managing the AIDS-causing virus. Without any possible cure for HIV, LAI should be supported and planned as the next solution to the HIV epidemic. It will save millions of lives, and particularly the ones in the developing countries who may not have access to the daily dose. The quicker the LAI advances and spreads faster to other nations, the better.
LAI is the ideal strategy in eradicating the barriers in the treatment and management of HIV. Daily HIV oral dosage has remained the large barrier to control and manage of HIV epidemic. The LAI is the future of the ARVs, and as a result, more efforts to regulate them fully including recognizing them as an alternative to oral ARVs will be a huge success in the efforts to contain HIV/AID menace.