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IAS 2019 – Long-acting HIV medications

Neal Sheran

Research on long-acting HIV medications

Dr. Neal Sheran shares information about long-acting HIV medications currently being studied—including who might benefit from them, and some outstanding concerns from the medical community.

Neal Sheran


Now we’re looking towards the future of how we can treat HIV in a way that is less burdensome for the patient, less toxicity, and medications that work for resistant viruses.

There’s lots of incredible research that’s being done on HIV treatment. One side is HIV cure strategies, where we hope to find a cure for HIV, and then there are other research strategies looking at long term medications. So instead of taking a pill every day, you take a medication either an injection that lasts a month, and even some research looking into medications that would slowly release medication on a daily basis. But you wouldn’t have to administer the medication more than once a year, or once every few years. Possibly a depo medication, or nanoparticles that would be delivered below the skin, that would release the medication over a long time.

I think there are several populations where this would be really great for. One that readily comes to mind, people who are long-term survivors or even people who have been taking medications for a long period of time. There is a very real pill fatigue issue, where people just, for whatever reason, find it really difficult to take their medications on a daily basis. This would be a great treatment option for them.

Additionally, lastly, populations that this would be really helpful for are international populations that have decreased access to health care. So if it’s difficult to access medications, on a monthly or daily basis from a clinic or pharmacy, you could visit patients, or have them come once a year for a year’s worth of medication that could be released.

One downside of these medications is that if say you do an injection, some of the half lives of these medications can stay in your system for several months after an injection. If you have any bad side effects or worse, any toxicities from these medications, then there’s no great way of getting the medication out of your system.

The second thing that can raise concerns are issues around resistance. Some of the trials that have been done on these long-acting injectables, did find that even with adherence, even if the patients were getting injections once a month, there was still some resistance that is seen. It is particularly seen in a type of HIV we generally don’t see in the United States, but it’s still a possibility.

Lastly, in terms of issues with resistance, is that once again if you get an injection and you don’t come back the next month for your next injection, if you fall out of care or have bad side effects, then there’s an issue of having a little bit of drug in your system, but not enough to suppress the virus. So then that would open you to more risk of resistance as well. 

The Dr. Is In

Twice a month, on the first and third Tuesdays of the month, Dr. Sheran brings HIV experts to San Francisco AIDS Foundation for The Dr. Is In, an HIV health and wellness discussion series. Join us for an opportunity to learn more about the latest research and information about living well with HIV, and get your questions answered by an HIV specialist.

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