New injectable drugs give hope to HIV fight

Joint Clinical Research Centre (JCRC), a government-research entity, said the country is looking at two types of long-acting injectable Anti-retroviral drugs (ARVs) to tame the HIV/Aids epidemic in the country. 

Dr Cissy Kityo, the JCRC executive director, yesterday said one of the injectable ARVs (treatment) is given once every two months and the other is given once every six months, allowing convenient dosing for patients.  

“The available treatment is at least one pill a day, before this, patients used to take many pills. [But] People get fatigued from taking pills every day. We are looking at long-acting anti-retroviral therapy (ART), which is given every two months. These are drugs called CABOTEGRAVIR AND RILPIVIRINE (CAB and RPV),” she said.

Dr Kityo added: “We are currently doing research across Uganda, Kenya and South Africa, this is the first study of its kind that is coordinated by the JCRC to evaluate these injectable ARVs on the African continent.” 

She said this would be essential in addressing the issue of low adherence to medication by decreasing the frequency of taking pills. She said low adherence is a major challenge to the country’s ambition of ending AIDS as a public health threat by 2030. 

“There are other drugs that have been approved in the United States which can be given every six months instead of giving every two months. This is a research that we are going to be doing to see how these drugs can be used, especially with patients who have become resistant to the available ARVs. For the drug that is given every after six months, we are still in the planning stages and we will most likely start it next year,” she added.

The U.S. Food and Drug Administration (FDA) announced last December that they “approved Sunlenca (lenacapavir), a new type of antiretroviral medication for adult patients living with human immunodeficiency virus type 1 (HIV-1), whose HIV infections cannot be successfully treated with other available treatments due to resistance, intolerance, or safety considerations.”

“After the starting dose is completed,” FDA noted in a December 2022 statement on their website, “Sunlenca is administered as subcutaneous (under the skin) injections once every six months, allowing convenient dosing for patients.”

Dr Kityo spoke yesterday on the sidelines of the JCRC 15th Annual HIV Update Meeting in Kampala, which happened a day after the Uganda AIDS Commission (UAC) revealed that more than 51,000 new HIV infections and more than 17,000 deaths were registered in the country in FY2022/2023.  

According to information from the UAC, adherence to ARVs, a critical parameter for reducing deaths and transmission, was at 73 percent, a decline from 96 percent in FY2020/2021. 

People who adhere to the medication have good viral load suppression which reduces their death risk and also reduces the risk of transmission during sexual intercourse, according to the UAC. 

During the meeting, Dr Jane Ruth Aceng, the Health Minister, said although there are challenges, the country has already made significant progress in the HIV fight.

“We are only challenged by adherence [to medication]. We are having issues with children. JCRC has been our investigative arm that gives us up-to-date Information on the progress on HIV –getting firsthand information on what is happening globally. We are only looking forward to two major things –the injectable treatment and the cure for HIV,” the Minister said. 

JCRC, Dr Aceng said, is an organisation that has tripartite ownership, Ministry of Health, Uganda People’s Defence Force, and Makerere University.

Dr Kityo revealed that trials on CAB and RPV, that JCRC is coordinating, started in 2021, and has already completed 12 months.

“We recruited 512 participants from three countries and by August this year, all of them had completed 12 months. But we have to follow all of them for 12 months in total. So the results are being written up and we will present at an international meeting,” she said.

Dr Kityo added: “Along with Baylor Uganda, we are evaluating the long-acting ARVs in adolescents, 12-19 years. That one has started recruiting this year, and participants will be followed up for 24 months.” 

Prevention injectable drugs
This development comes at a time the UAC says it is waiting for National Drug Authority to approve the long-acting cabotegravir used for prevention of HIV infection.

Dr Kityo explained that for treatment, the injectable ARV drug cabotegravir is given together with another injectable ARV drug, rilpivirine, once in two months. 

“Cabotegravir has also been approved by the Ministry of Health to be used (alone) for prevention of HIV infection,” Dr Kityo said.