The following is a video and transcript excerpt from an interview conducted with David Alain Wohl, M.D., discussing highlights and clinical takeaway messages from the 2021 Conference on Retroviruses and Opportunistic Infections (CROI 2021), which took place in March. In this video, Wohl talks through new data regarding long-acting antiretroviral therapy for HIV—and touches on the uncertainties clinicians face in incorporating this new treatment method into their practice.
I’ve been sort of a booster of long-acting injectables as an option, [though] I don’t think the majority of people will want to take an IM [intramuscular] injection, even though [it will likely be] a couple of IM injections every two months. But I do think it’s something important to have as an option for people to decide against or for. I’m big into people having choice.
There is a substantial minority of people right now who do opt for this and who do very well with it—and, for a bunch of different reasons, prefer it to taking a pill. That’s data that we’ve seen from the manufacturers of these compounds and even some independent work, including for PrEP, where people say, you know, “Yeah, I would rather take an injection than a pill.” So, true for therapy, true for prevention.
At this conference, we saw longer-term data [on efficacy and safety]—especially from the ATLAS-2M study, which was looking, importantly, at every-two-month administration of cabotegravir and rilpivirine [LA-CAB/RPV, Cabenuva]. Right now, we’re rolling out every-monthly injection—and if it wasn’t for the pandemic, there’d be a lot more buzz about this.
But our clinic here in North Carolina is strategizing how we’re going to do this: what’s the logistics; having conference calls about follow-up of people; what to do if people drop off; et cetera—all the things we’ve been anticipating for a while—and the ins and outs of doing the oral lead-in, et cetera.
I was glad to see that there’s longer-term data from the study. And I thought that they were—again, not too surprising, reassuring—that there was high-level suppression of viremia in both Q8-week and the Q4-week arm, [and] resistance [was] really uncommon.
There was also this nice analysis that, I think, we have to translate into something that’s easy: you could put on a laminated card about what to do when people miss a dose or [are] delayed in their dose of their IM. Because that comes up all the time, and I think the pharmacologists and the pharmacists are going to have to help us with this.
But looking at the different scenarios, I think, helps us understand how we should manage this, and make it almost algorithmic. We shouldn’t have to be guessing what to do, you know, when there’s a gap of X amount of weeks or X amount of time [between doses]. And I think some of the modeling data that we saw around cabotegravir and rilpivirine helps us understand how to manage these people.
Those are the kind of data we’re going to need. I feel like we’re a little ill-prepared right now, most of us, for introducing this into the clinic, and need as much data as possible. And it has to be very practical.
So, for me, I think that’s what CROI added. You know, whether we like it or not, CAB is coming, CAB/rilpivirine, and we’re going to be injecting people’s butts with this stuff.
[Related: Long-Acting HIV Treatment and PrEP Pipeline Update: So Many Formulations!]