Daily versus supposed monthly ARV dose

A couple of medical doctor friends and I had a brief discussion about HIV/Aids recently. They intimated to me a certain misconception that was going around. People living with HIV/Aids and on treatment, were coming to them with requests for a ‘certain’ drug that is taken one tablet a month and works as effectively as the daily dose of ARVs. While this would definitely be good news, the only possibility is a drug called Cabotegravir according to Medical Daily.
However, this drug is under research and still a long way from being approved. Cabotegravir is in fact, an injection.

However, as per my colleagues, the tablet that is causing this misconception is a combination of Tenofovir (TDF), Lamivudine (3TC) and Effavirenz (EFV). This combination of drugs is considered first-line (first above all alternatives after thorough assessment) according to the World Health Organisation (WHO). As an option to Lamuvidine, Emitricitabine (FTC) can be used in the above combination. The tablet is taken once daily and not once monthly.
To understand this further, we look at what happens to drugs when they get into the body. When research is done prior to a drug being approved for human use, a certain dose is determined to be effective to treat/cure a disease or fight the disease causing germs.

When we swallow tablets, they have to go through the liver. In the liver, they are modified to suitable forms which increases their ‘accessibility’ to the body. However, a certain percentage is always lost. But whatever is left has already been scientifically determined to be effective. And then after sometime, the drug in its new form or not is eliminated from the body.
This lowers the level and the amount of drug in the body is no longer efficient. So in order to maintain the effective dose, we have to keep taking the drug. The rate of elimination determines how often we refill or take more medicine. In the above combination, it is once a day. And this cannot be modified to once a month. So this misconception should be corrected.

For those who cannot take the above combination, other alternatives can be sought. The same combination is recommended as first-line ART in pregnant and breastfeeding women, including pregnant women in the first trimester of pregnancy and women of childbearing age. “The recommendation applies both to lifelong treatment and to ART initiated for Prevention of Mother to Child Transmission (PMTCT) and then stopped,” as per World Health Organisation.

The writer is a pharmacist