Thousands of people living with HIV in Britain are to be freed from the burden of taking daily pills, after health chiefs gave the green light for a revolutionary treatment by injection every two months.
Draft guidance from the National Institute for Health and Care Excellence (Nice) recommends offering the antiretroviral drugs cabotegravir and rilpivirine in England and Wales after trials proved they work as effectively as daily tablets.
The Scottish Medicines Consortium has also approved the injections for adults living with HIV in Scotland.
Although HIV, which attacks the immune system, is still incurable, researchers found that patients who had the new treatment could reach a point where the virus particles in their blood (the viral load) were so low those particles could not be detected or transmitted between people.
“We still have a long way to go in educating around HIV, but today’s announcement demonstrates how far we’ve come since the 1980s epidemic,” said Garry Brough of Positively UK. “It is a huge step forward. Having to take tablets every day can be physically, emotionally and socially burdensome for some people. This decision reflects the rightful need for people living with HIV to have the freedom to manage their HIV in a way that works best for them, helping them to live their life to the full.”
Debbie Laycock, head of policy at Terrence Higgins Trust, described the breakthrough as “incredible news”.
The treatment is the first long-acting, injectable treatment for adults with HIV. It is also the first recommendation Nice has made about the use of HIV treatments since they came under its remit two years ago.
Cabotegravir with rilpivirine is now being recommended as an option for adults with HIV infection when antiretroviral medicines they are already taking have kept the virus at a low level, and where there is no evidence to suspect viral resistance and no previous failure of other anti-HIV medicines.
About 100,000 people have HIV in Britain. It is estimated that initially at least 13,000 people will be eligible for the new jab in England alone.
At present treatment for HIV involves life-long antiretroviral regimens taken as tablets every day. Clinical trial results show cabotegravir with rilpivirine is as effective as oral drugs at keeping the viral load low. The antiretrovirals are administered as two separate injections every two months.
Chloe Orkin, professor of HIV medicine at Queen Mary University of London, said: “This is a paradigm-shifting moment in the UK where, for the first time, it is possible to release people with HIV from the burden of daily oral therapy and offer them instead just six treatments per year.”
Deborah Gold, chief executive of the National AIDS Trust, said: “Long-acting injectables have been proven to be a safe and effective method of delivering HIV treatment, so we are delighted that Nice has approved the use of cabotegravir with rilpivirine for adults living with HIV.
“It won’t be right for everyone but, for some, monthly injections are highly preferable to daily pills. Innovations that can make it easier for people to stick to their treatment plans both improve the wellbeing of people living with HIV and bring us one step closer to the goal of ending transmissions by 2030.”
A treatment only required six times a year will make taking medicine easier for some people, and is more discreet for those who feel unable to be open about their HIV status. Experts say removing the need to take pills every single day may also lessen the emotional toll of living with HIV, and improve the numbers of people who adhere to their treatment regime.
Meindert Boysen, deputy chief executive and director of the Centre for Health Technology Evaluation at Nice, said: “Despite scientific advances HIV is still incurable, but the virus can be controlled by modern treatment. However, for some people, having to take daily multi-tablet regimens can be difficult because of drug-related side effects, toxicity and other psychosocial issues such as stigma or changes in lifestyle. The committee heard that stigma remains an issue for people living with HIV and can have a negative impact on people’s health and relationships.
“We’re pleased therefore to be able to recommend cabotegravir with rilpivirine as a valuable treatment option for people who already have good levels of adherence to daily tablets, but who might prefer an injectable regimen with less frequent dosing.”