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Long-Acting ART
Long-Acting ART: A Matter of Choice

Released: September 27, 2019

Expiration: September 25, 2020

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Following recent positive data from the phase III ATLAS and FLAIR studies, the growing possibility of long-acting ART becoming available for people living with HIV has many in the field asking who are the best candidates for such treatment.

In the qualitative research we conducted with patients and providers participating in the phase II LATTE-2 study of injectable cabotegravir and rilpivirine, some patients believed that “everyone living with HIV” would benefit from this long-acting regimen.

The participants in the study cited many reasons why receiving their HIV treatment as a periodic injection was a welcome opportunity: It removed the challenge of daily pill taking, it reduced opportunities for stigma, or it simply worked well for the individual’s lifestyle. However, some patients may not be as well suited for or interested in a long-acting regimen, including those who are already comfortable with a daily pill regimen, those with a fear of needles, or those with a travel schedule that may prevent them from attending routine injection appointments.

Provider Perspectives
In contrast to the patients, providers expressed concerns about clinic adherence and how to ensure individuals were adherent to the injection appointments. In fact, in our interviews with providers, a tension arose between whether adherent or nonadherent patients receiving oral ART would be appropriate candidates for long-acting ART.

Does a long-acting injectable therapy solve the problem of poor adherence because it is taken less frequently? Or does poor adherence—either to clinic visits or to daily treatment—suggest that a person would also have poor adherence to monthly or every-other-month treatment, raising a concern around drug resistance if the patient does not come back on time?

Many providers said it would be best to consider candidates on a case-by-case basis, especially considering that many patients can take daily pills without any problems, so a new regimen is not necessarily needed.

Choice
To me, the most important aspect of the potential availability of a long-acting regimen is the ability to meet the needs and preferences of different individuals, providing an alternative to a daily regimen. Having a long-acting option simply introduces an element of choice for the patient. Perhaps the question is not which patient is most appropriate, but how can we support patients who choose this option?

This suggests the need to support patient–provider communication around evolving therapeutic options, including the need for assessment tools to help clinicians navigate the various factors to consider when deciding who may be appropriate candidates for long-acting ART and when and how to support patients transitioning between regimens based on changing social and clinical dynamics.

Your Thoughts?
What patient characteristics do you think are important to consider for long-acting ART regimens? Answer the polling question and add your thoughts in the comments section.

Then, to hear me and other HIV experts discussing long-acting ART and other innovative paradigms for ART, see our CME-certified video and read our responses to frequently asked questions.

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If long-acting injectable ART were available, which patient characteristic do you see as the MOST important consideration before you would suggest it to them as a treatment option?
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