Among perceived downsides to LA-ART is the need for current drug candidates to be administered via injection, which could lower demand. However, "[p]arenteral therapy is widely accepted for a number of very serious chronic diseases" including Type 1 diabetes and rheumatoid arthritis, Flexner countered, suggesting there is little reason to expect the case would be different with HIV.
Flexner cited results from a survey he led in 2013 that found widespread approval of injectable therapy among people living with HIV. In his study, the majority of respondents said they "probably" or "definitely" would want to receive parenteral treatment. That preference held regardless of the proposed dosing schedule, although acceptance was particularly high (84%) when the theoretical dosing of an injectable regimen was only once per month.
Other surveys show very similar results, Flexner said. "The enthusiasm for injectable therapy is very high in our patients, especially in high-income and middle-income countries. In fact, my experience is that our patients are more enthusiastic about this form of therapy than health care providers are."
The advantages of LA-ART are obvious, Flexner said: infrequent dosing; the potential for lower doses than oral medications using nanoformulations; and the prevention of poor adherence on oral antiretrovirals, thanks in part to the likelihood of directly observed therapy, tissue targeting of the injectable therapy and the countering of fill fatigue with periodic injections.
Flexner also offered that less-frequent treatment dosing could protect HIV-positive people's health privacy and reduce stigma by eliminating their need to fill prescriptions and carry or store pills.
Image credit: Myles Helfand via Canva.