Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

New HIV Treatment Administered Monthly

Dear Doctor: What can you tell me about the new monthly HIV treatment that was recently approved? My uncle has been living with HIV for almost 25 years. He’s a senior citizen now, and growing forgetful about all of the meds he’s on.

Dear Reader: You’re referring to a monthly injectable HIV treatment that was just given the green light by the U.S. Food and Drug Administration. It’s an extended-release drug -- the first of its kind to win FDA approval -- and it will be a game-changer for a lot of people living with HIV. The treatment, which comes in a two-shot combination, isn’t for everyone, and it comes with some caveats.

Human immunodeficiency virus, or HIV, is a virus that attacks the immune system. Left untreated, it can cause the disease we know as AIDS, or acquired immunodeficiency syndrome. It’s most often spread through unprotected sex or sharing syringes with an infected individual. It can also be acquired in a medical setting via infected blood products. However, since the implementation of HIV testing of blood products and donated organs, this type of transmission is rare. While mother-to-child transmission during pregnancy, labor or breastfeeding is also possible, effective interventions have lowered that transmission rate to less than 5%.

At this time, about 1.2 million people in the U.S. are living with HIV. About 14% of them -- that’s 1 in 7 -- aren’t aware of their HIV-positive status.

Until the advent of antiretroviral therapies in the early 1990s, the average life expectancy of someone with AIDS was one year. Thanks to antiretrovirals, HIV/AIDS became a manageable chronic condition. At first, to prevent the virus from replicating and to limit drug resistance, treatment consisted of multiple medications taken throughout the day. This eventually changed to fewer pills, but for certain patients, including some older adults, this was still a challenge.

The newly approved drug, known as Cabenuva, is a complete regimen that gets injected once a month. It allows patients, like your uncle, to improve their compliance. They go from having to remember to take their medication 365 times per year to receiving the treatment monthly. Cabenuva combines an existing drug with a new drug, packaged together and given as two separate shots. An every-other-month regimen, which is already available in Europe, is being tested in the U.S. The FDA also approved the new drug in tablet form, to be taken for a month prior to starting the injectable therapy. The goal is to prep the body for a smooth transition to the injectable drug.

As with all drugs, the new injectable therapy has potential side effects. These include fatigue, headache, joint and muscle pain, swelling at the injection site, rash, dizziness and trouble sleeping. Cabenuva is meant for people who are already on a successful HIV/AIDS regimen, with no previous treatment failure, and who have no history of resistance to the antiretroviral drugs in the injectable. The therapy, which is eligible for insurance coverage, cannot be administered at home and requires monthly clinic visits.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)