How can science improve on its own miracle?
This is the conundrum at the heart of an ongoing conversation in HIV medicine over the future of long-acting antiretroviral therapy, or LA-ART. The promise of LA-ART lies in the freedom it can potentially offer people living with HIV from the traditional burdens of treatment: LA-ART drugs can theoretically be administered as infrequently as once every several months, as opposed to the daily oral dosing that is generally required today.
The invention, production, and increasing global distribution of daily oral antiretroviral therapy for HIV is, in itself, "one of the great success stories of medicine of the last century," said Carl Dieffenbach, Ph.D., at the Controlling the HIV Epidemic Summit in Geneva, Switzerland, on May 3. "Antiretroviral therapy is a modern miracle -- provided people adhere to therapy."
Dieffenbach, the director of the Division of AIDS within the National Institute of Allergy and Infectious Diseases, spoke before the international gathering of leading HIV care providers and policy experts to offer an update on how ready the world is to utilize LA-ART and improve on the modern miracle. The title of Dieffenbach's talk included a provocative question: "Are we ready?"
It would be easy to assume the answer is yes, given that a pair of long-acting HIV drugs are already making their way into the world: ibalizumab (Trogarzo) was approved by the U.S. Food and Drug Administration (FDA) in March while albuvirtide got a green light from the Chinese Food and Drug Administration in June.
But two drug approvals in two countries do not equal a complete, successful rollout. "I'm maybe a little hesitant to say we're ready," Dieffenbach said.