Monthly HIV injections cuts treatment failure in half, offering hope for 126,000 Kenyans

People living with HIV who struggle to take daily medication and maintain an undetectable viral load may soon have a far more manageable option: a monthly injection. A major clinical trial has now proven this long-acting regimen to be significantly more effective than the daily pill.

The LATITUDE trial specifically enrolled the patients that most programmes quietly give up on; those who had stopped taking their antiretroviral drugs, been lost to follow-up for months, or maintained dangerously high viral loads despite having an active prescription. These were not patients who didn't want to get better, but those for whom the daily discipline of HIV treatment had become an impossible ask.

Also read: New weekly HIV pill matches daily treatment in landmark global trial

According to the findings, monthly injections of cabotegravir combined with rilpivirine, two antiretroviral drugs delivered as a long-acting injectable formulation, were superior to continued daily oral antiretroviral therapy in reducing treatment failure among people with HIV who had documented adherence challenges. Researchers say the implications should reshape how every country managing an HIV epidemic approaches the patients not being reached by the current standard of care.

The trial, presented during the just-concluded International AIDS Society conference and published in the New England Journal of Medicine, enrolled 453 participants across 33 sites in the United States, with 63 per cent of the participants being Black.

The trial unfolded in two steps. In the first, participants received up to 24 weeks of adherence support, counseling, and conditional financial incentives tied to viral-load reduction and clinic attendance. Of the 453 enrolled, 306 achieved viral suppression sufficient to proceed to the second step.

In step two, participants were randomly assigned either to continue their daily oral antiretroviral regimen or to switch to monthly injections of cabotegravir-rilpivirine.
The injections were administered at the clinic, no remembering required, no daily decision, no pill bottle to hide or forget.

Among those who received the monthly injections, regimen failure, defined as either confirmed viral rebound or permanent treatment discontinuation, occurred in 22.8 per cent of participants by week 48. Among those who continued daily oral therapy, regimen failure occurred in 41.2 per cent, nearly double.