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“Fourth 90” and LA ART
Achieving the “Fourth 90” With Long-Acting ART?

Released: July 11, 2023

Nikos Dedes
Nikos Dedes,
Activity Information

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Key Takeaways
  • For years, the target of treating a person living with HIV was to achieve viral suppression. The “fourth 90” expresses a paradigm shift toward patient-centered care aiming to improve and maintain health, well-being, and quality of life, all represented as health-related quality of life.
  • Use of long-acting antiretroviral therapy may represent an opportunity to improve health-related quality of life in some people living with HIV. 

On Tuesday, July 25, 2023, I will be part of a symposium at the 12th IAS Conference on HIV Science in Brisbane, Australia, focused on reaching the “fourth 90” and exploring how long-acting (LA) antiretroviral therapy (ART) may play a role in achieving this target. I invite you to read more about this topic below and then register to hear more at the live interactive symposium, either in person or virtually.

The “Fourth 90”
Innovations in HIV therapeutics have resulted in a range of ART regimens that are highly effective and well tolerated. Thanks to these successful ART regimens, it has become increasingly possible for people living with HIV to achieve the UNAIDS 2025 95-95-95 targets.

With improved progress toward achieving these targets, there is increasing focus on strategies to achieve a “fourth 90.” The target is that 90% of people living with HIV achieve and maintain good health-related quality of life (HRQoL) comparable to that of the general population.

Although not officially included in the UNAIDS 2030 targets, this “fourth 90” is widely accepted as a goal to strive toward. It brings attention to the broad range of health challenges that people living and aging with HIV face, including those related to comorbidities and especially mental health. In turn, there has been a new emphasis on evaluating patient-reported outcomes to assess the impact of HIV treatment and care on the quality of life of people living with HIV.

Aspiring to achieve a “fourth 90” represents a paradigm shift that acknowledges that simply achieving virologic suppression in people living with HIV is not enough—treatment of people living with HIV is not successful until good quality of life is achieved.

With use of effective ART, the life expectancy of people living with HIV is similar to that of the general population. However, living longer does not always equate with a good quality of life. People living with HIV are at higher risk of developing other medical, mental health, and cognitive conditions, including cancers, cardiovascular disease, diabetes, frailty and other physical limitations, anxiety, depression, and difficulty sleeping. People living with HIV frequently encounter internal and external stigma and discrimination in their daily lives, which can exacerbate their health issues.

The challenge in today’s world is to identify key issues that health systems must address to move beyond a focus on viral suppression and advance the long-term health and well-being of people living with HIV. It is imperative to integrate care and services to improve HRQoL. For some people living with HIV, LA ART is one option that may be helpful in some aspects of HRQoL.

Can LA ART Play a Role in Improving HRQoL?
The advent of LA ART represents a potential opportunity for some people living with HIV to decrease their pill burden and frequency of medication administration, although it may result in new types of potential drawbacks.

Questions that come to mind when I think about whether LA ART may play a role in improving HRQoL include:

  • For those who choose LA ART, how will they feel about the clinic visits for injections?
  • How do type and frequency of adverse events with injectable therapy compare with those with oral therapy?
  • Can use of injectable therapy improve treatment confidentiality?
  • How might use of LA ART reduce stress or reminders of HIV status?
  • Is LA ART more beneficial for some key populations of people living with HIV?
  • What are the potential benefits and risks of self-administered LA ART?

We will explore questions like these at our interactive panel discussion–based symposium at IAS 2023 in Brisbane, Australia. You can join us in person or by live webcast to hear expert faculty discuss the importance of improving the well-being of people living with HIV, including an explanation of the “fourth 90” concept, first-hand accounts of how LA ART may affect well-being, and challenges and opportunities for LA ART implementation.

IMPORTANT NOTE: This live event will be available only to registered in-person and virtual attendees of IAS 2023. If you have registered for IAS 2023 and would like to participate, please proceed to the in-person program or the conference online portal provided by the organizers. If you have not registered for the conference, you may do so here.

Your Thoughts?
What do you perceive as important measures of HRQoL for people living with HIV? Join the discussion by posting a comment.