People with HIV from rich countries may have to choose within not much between two options on how they want to control the infection: whether to do it with a pill a day, or whether to do it with two injections a month. The first is what happens now; the second, what is close according to data from two trials that have been presented at the Conference on Retroviruses and Opportunistic Diseases (CROI) that was held last week in Seattle (Washington, USA).
Both works use the same combination of two drugs that are administered by an intramuscular injection, in one case for people who were already in treatment (the FLAIR trial) and in the other, as the first choice of therapy (The atlas). And the conclusion after 48 weeks is that the results are not worse than those obtained by the combination of antivirals already established.
Although the drugs used are from two of the families that already exist, the different form of administration and the possibility of spacing the intakes make this approach considered very interesting by specialists. The possible advantages, according to a qualitative previous work, they are the easiness of following the treatment, which avoids having to be aware of taking the pills every day or of taking them when going on a trip, which decreases the possibility of having to give explanations to people who do not want to reveal their status. The drawback is, clearly, that the injections have to be given, although the tests have detected that the main adverse effect is the local at the puncture site.
The other breakthrough is that they show that you can control the infection with two drugs instead of three, which reduces the toxicity associated with products that have to be taken throughout life, and can lower the cost of treatment.
"These are excellent studies with very solid data and very relevant for patients," said Marisa Montes, of the board of directors of Gesida (AIDS Studies Group of the Spanish Society of Infectious Diseases and Clinical Microbiology).
"The results are of great importance since they represent the biggest change of paradigm in the antiretroviral treatment of the last two decades. These studies have shown in a large number of patients that three drugs are not necessary for the control of HIV infection, since a two-drug regimen is comparable in terms of efficacy to traditional triple therapy, "said Mar Masiá , from the Elche hospital, which has participated in both jobs.
"Patients could benefit in the future thanks to the possibility of using a regimen that includes a smaller number of drugs. Being a therapy that is going to have to be administered for life, it is a clear advantage in terms of reducing long-term toxicity. In addition, intramuscular administration with monthly periodicity facilitates adherence and the risk of forgetfulness and therefore there are infraterapeutic levels of the regimen and, above all, it improves the quality of life of the patient, since it allows him to avoid dependence on memory of the daily intake of the drug, improves their freedom of movement, allows them to forget that they have the infection, etc. ", added Masiá.
In the world there are about 37 million people with HIV, according to the latest estimates, of which about 140,000 live in Spain (the figure is never exact because it is estimated that there are about 18% of people with the virus who do not know ). Of the total, around 40% still do not receive any treatment, partly because of the cost, partly due to the lack of accessible healthcare systems, but also, as explained by Lelio Marmoa, president of Unitaid, in a recent visit to Madrid, because belong to groups persecuted in their countries (gays, people who are dedicated to prostitution, drug users) for which facilitate the test (the organization will distribute 20 million self-test equipment) and receiving the subsequent medication is key.