Long-term HIV treatment: a promise for Africa

March for Science in Durban, South Africa, April 14th 2018.
March for Science in Durban, South Africa, April 14th 2018. RAJESH JANTILAL / AFP

A promise is emerging. To see, within a few years, HIV-positive people treated with an injection every two or three months, with a band-aid, implant or progressive-release capsule. To be able to protect HIV-negative people from contamination by taking one capsule every two weeks. The hope of ending the constraint of taking daily drugs, which remains a powerful brake to control the disease and can lead to treatment failure. In Africa as elsewhere in the world.

Presentation of our series AIDS, the new weapons of Africa

"Such scenarios could be realized in the next decade" I believe Lelio Marmora, director of Unitaid and co-author of an article published in the scientific journal The Lancet, October 24th. Especially in developed countries, there are already long-term treatments for various diseases such as schizophrenia, severe asthma or opioid addictions that give better results than conventional treatments. "Against HIV, long-acting injectable drugs are the most advanced "Summarizes the article.

"Injections from 2019"?

Whether it is care or prevention, several studies are under way. On September 18, the ViiV Healthcare laboratory announced the first results of a clinical trial, judged " very satisfying From Professor Jean-Michel Molina, Department for Infectious and Tropical Diseases, Saint-Louis Hospital, Paris. This process called "Atlas" was conducted on 618 adults living with HIV in several countries: Argentina, Canada, France, South Africa, etc. All were treated and had undetectable viral load for more than six months. The study compared two treatments: the monthly injection of a dual therapy with a triple standard therapy performed orally. After forty-eight weeks, the monthly injection was just as good, in terms of controlling HIV, as the triple therapy taken daily. " This injectable treatment could be marketed as early as 2019 "Says Carmen Pérez Casas, co-author of the article of Lancetta e responsible for HIV at Unitaid.

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With regard to prevention, the assessment of pre-exposure prophylaxis (PrEP) based on a single molecule administered as injections every 1-3 months is underway. Two large clinical trials compare this strategy with the daily oral use of antiretrovirals usually given to protect against at-risk sex. The first is conducted among approximately 4,500 homosexual men in 43 sites worldwide, including South Africa. The second, among 3,200 sex workers in 20 sites in Sub-Saharan Africa (Botswana, Kenya, Malawi, South Africa, Swaziland, Uganda, Zimbabwe).

African challenges

Will these treatments be adapted to the African continent? This is the big question. " We must remain cautious. These long-acting injectable products may be of interest to Africa. But they face new challenges. Injections, in particular, impose a sterile material "Jean-Michel Molina says," Another difficulty: the cold chain, which must be respected for one of the molecules, rilpivirine. "" On the other hand, it takes time before the patient's body eliminates these drugs, which can lead to resistance problems but also to harmful interactions with other drugs.

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On the continent, however, the most appropriate solutions could come from the implant inserted in the arm, preventive vaginal ring, transdermal patch or slow-release capsules within a week. These devices do not require cold chain or sterile injection equipment. " In Africa, implants and other long-lasting formulations have already radically changed the way contraception, underlines Carmen Pérez Casas. We must continue to explore solutions that are better adapted to the continent. "

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But it will take some years before these anti-HIV devices are available. Because, to the technological and medical challenges, there is another challenge: to shorten the access time of the African countries to these biomedical revolutions. Work made complex by sharing patents between three types of entities those who develop the molecules against HIV, those who develop the media that will contain the drug and those who develop the processes of reformulation of these drugs. A challenge of another order, but no less crucial.

This article is part of a series produced in the context of a partnership with Unitaid.

Summary of our series of AIDS, the new weapons of Africa

Florence Rosier

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