Now that long-acting antiretroviral therapy (LA-ART) is nearly a reality, is it something that people with HIV will prefer over once-daily pills? A study presented during a poster session at the International Conference on HIV Treatment and Prevention Adherence tried to find out whether LA-ART was as acceptable as daily-pill ART among 374 people living with HIV in a clinic in Houston. While they found that overall, LA-ART was acceptable among a majority of people, it wasn't equally acceptable among all groups.
Researchers conducted this study as a survey of the 374 participants in a clinic in Houston who agreed to fill it out and to have their medical charts further reviewed for demographic information and medical history. Participants were asked to select the modality they preferred most, if all the options cost the same and were equally effective. The mean age was 49, and a majority were U.S.-born, male (64%), and black (63%).
Over 60% of all participants said they were very likely or likely to use a new LA-ART if available, compared to 39% who said they were less likely to use it. When asked which method they preferred, 41% preferred pills, 40% a long-acting injectable, and only 18% preferred a long-acting implant. Nearly three-fourths of all respondents thought that the benefit to LA-ART would be in not having to remember to take daily pills, yet 43% were worried the long-acting options would work less well than pill-form ART.
"What was interesting that we were not expecting was that many people want to try [LA-ART], but when you force them to choose the best method to take their medication, 41% still wanted pills," said Dima Dandachi, M.D., lead researcher of the study, which was conducted at Baylor University.
When researchers further looked at which variables were associated with wanting to switch to LA-ART, those with some college education and those who were gay or bisexual, on twice-daily ART, or who had difficulty scheduling or attending clinic visits all preferred the long-acting options.
"I think in their minds, the long-acting injectables will be easier to take than a daily pill, but they don't know they may have to take the injection in the clinic every month," said Dandachi.
The National Institutes of Health (NIH) announced in May that it is funding the LATITUDE study, which will look to determine the superiority of the cabotegravir/rilpivirine monthly long-acting injectable over daily-pill ART for people who struggle with maintaining a daily pill regimen.
"Monthly injectable antiretroviral therapy may prove more convenient, discreet, and appropriate for some people living with HIV," said Aadia Rana, M.D., associate professor of medicine at the University of Alabama at Birmingham Center for AIDS Research and protocol co-chair of LATITUDE, in an NIH press release. "Our study aims to help people living with HIV and facing challenges with adherence find a treatment option that meets their health needs and fits into their lives, allowing them to experience the health benefits of becoming durably virally suppressed."
Whatever the results of LATITUDE, the health care system for people living with HIV may not be prepared to handle even a small proportion of people who choose to use LA-ART. TheBodyPro reported in April on a talk given by Melanie Thompson, M.D., of the AIDS Research Consortium of Georgia, during which she detailed the systemic challenges that must be addressed to make LA-ART a reality for people who want to switch.