HIV TREATMENT - THEN AND NOW
by Mark Shaefer, Pharm.D.
Over the last 30 years, we’ve seen major advances in the development of HIV treatment. Within a single generation, people living with HIV have gone from needing multiple tablets, multiple times a day to – in many cases - a single pill, taken once a day.
Breakthroughs in HIV science have led to improvements in the efficacy of today’s HIV treatments, called antiretrovirals or ARVs, including reduced side effects and a smaller risk of long-term toxicities. This has, in turn, made it easier for patients to stay on their medicines. It has also played a key role in tackling HIV-related stigma and discrimination, addressing the emotional challenges that may come with regularly taking medication.
However, while we’ve come a long way since the early days of HIV treatment, challenges persist in our fight to end the HIV/AIDS epidemic and we are still searching for a cure. Faced with the fact that an HIV diagnosis can mean a lifetime of exposure to ARVs, as well as to social and self-stigma, we know that more needs to be done to make HIV a smaller part of peoples’ lives.
“People living with HIV have gone from needing multiple tablets, multiple times a day to – in many cases - a single pill, taken once a day.”
At ViiV Healthcare, we’re committed to developing innovative new therapies that offer people living with HIV a wider range of treatment options, empowering them to make decisions which best support their overall well-being.
But why is choice so important when it comes to HIV medication?
HIV treatment – then and now
The first antiretroviral drug used to treat HIV, azidothymidine (AZT), was discovered by scientists at Burroughs Wellcome (now GlaxoSmithKline, ViiV Healthcare’s majority shareholder) in the early 1980s – a breakthrough moment for the HIV scientific community.
Approved by the US FDA in March 1987, AZT works by limiting the replication of HIV-infected cells, suppressing the virus and slowing its growth within the body. This provided a revolutionary means of treating HIV and paved the way for medicines prescribed today.
However, HIV treatment options remained limited, with most regimens requiring patients to take multiple doses of a number of pills each day. Back in the early days, people even had to set alarms in the middle of the night to wake up and take their dose.
The late 1990s saw a fresh wave of progress with the arrival of combination therapies – multi-drug regimens which help to prevent HIV from developing resistance to certain medicines and boost a patient’s likelihood of keeping their virus suppressed.
Committed to staying at the forefront of innovation, our scientists developed the first two-drug, fixed-dose combination tablets that would form the backbone of numerous HIV therapies. This was followed by the first single-tablet, three-drug regimen, given twice daily. The first of their kind, these combination tablets helped to relieve adherence anxiety, making it easier for people to remember to take their medication.
Thanks to further advances over recent years, the HIV treatment paradigm is continuing to shift. For many people living with HIV, fixed-dose combinations of HIV drugs are now available in single pills taken just once daily. Conscious, however, that more can be done to reduce the impact of daily therapy on people living with HIV, we’re shifting gears as we focus on developing the first long-acting HIV treatment.
Adherence – a crucial weapon in the fight against HIV
The effectiveness of HIV treatment is reliant on adherence to prescribed regimens. Regularly missing doses, for example, may prevent the medication from working properly, allowing the mutated virus to grow and spread through the body.
Providing options when it comes to HIV treatment is therefore vital. This enables patients to become more active participants in their HIV care, which can lead to better adherence and higher likelihood of suppressing the virus. As found in the first Positive Perspectives survey we conducted back in 2017, PLHIV who perceive themselves to be involved in their HIV therapy decisions are generally more convinced by and satisfied with their treatment.
This has a striking knock-on effect on not only the individual’s well-being, but also on their chances of transmitting the disease to others. If HIV treatment is properly adhered to and a patient’s viral load is reduced to undetectable levels, they are no longer at risk of passing on HIV to sexual partners, a fact that has led to #UequalsU: Undetectable equals Untransmittable.
“Providing options when it comes to treatment is vital. This enables patients to become more active participants in their HIV care, which can lead to better adherence and higher likelihood of suppressing the virus.”
Continuous innovation – a silver bullet against HIV stigma?
Beyond the clinical implications, novel modes of taking medication can also have a positive impact on the emotional well-being and quality of life of people living with HIV.
Due to the high prevalence of stigma around HIV/AIDS – often based on misinformation - many choose not to share their HIV status with friends or relatives. Just 3 in 10 of those PLHIV surveyed in 2017, for example, considered themselves generally open about disclosing their status. This can, in turn, spark concerns around storing and taking HIV pills without others knowing.
In addition, people living with HIV may also experience self-stigma, with over a quarter stating that they quite or very often have feelings of self-blame, guilt and a need for secrecy. Taking pills on a daily basis has the potential to exacerbate these emotions, acting as a constant reminder of the infection and its implications.
Recognising these challenges is crucial for scientific and research communities, so we can continue to optimise HIV medication in line with unmet patient needs and modern lifestyles. Equally important, however, is empowering and educating people living with HIV to be more aware of and involved in the therapy choices available to them.
“We continue to strive to find better ways for patients to make medication a smaller part of their life.”
Novel approaches to HIV treatment
Through our innovative efforts in research and development, we’re exploring the potential of novel types of antiretroviral treatment. These include longer-acting medications, such as injectable formulations, which would negate the need for pills, ensuring our portfolio has the diversity required to meet the varying needs of people living with HIV.
By developing HIV treatments that can be administered less frequently, we continue to strive to find better ways for patients to make medication a smaller part of their life. Our goal is to relieve patient concerns and give people more control over how and when they take their medicines, which we hope will lead to better long-term adherence, improved health outcomes and enhanced emotional well-being for people living with HIV.