Could long-acting injectable medicines replace daily HIV tablets in young people living with HIV in Africa?
22 Jun 2023
A new clinical trial has launched across sub-Saharan Africa in young people, aged 12-19 years, living with HIV. The Long-Acting Treatment in Adolescents (LATA) trial will test whether long-acting injectable HIV medicines, given every eight weeks, work as well as daily tablets to keep the virus under control.
This new approach could make it easier for young people living with HIV to stick to their treatment regimen, improving both health outcomes and quality of life.
An estimated 2.1 million adolescents live with HIV globally. 85% of these are in sub-Saharan Africa, where AIDS is the leading cause of death in adolescents.
HIV treatment usually takes the form of daily antiretroviral therapy (ART) tablets, which make sure the amount of virus in the blood remains low. This is called having an undetectable viral load. Those whose HIV is “undetectable" can usually live a healthy life with normal life expectancy.
However, it is challenging to take medication every single day for life. This is especially true for teenagers, who are less likely to stick to treatment in the long term, less likely to have an undetectable viral load, and who have higher mortality rates than older adults with HIV. Some of these challenges may relate to HIV stigma and fears that taking daily medication will disclose their positive HIV status to their peers.
But new forms of antiretrovirals, which can be given as long-acting injections, open up the possibility that people living with HIV may not have to take daily tablets. LATA is testing how safe, effective and acceptable these injections are to young people living with HIV.
The trial aims to recruit 460 young people living with HIV, aged 12-19, from Kenya, South Africa, Uganda and Zimbabwe.
The team will randomly allocate participants between two groups:
- Long-acting injectable group: participants will receive injections of two drugs called cabotegravir and rilpivirine every eight weeks.
- Continuous oral treatment group: participants will take ART tablets once a day by mouth. The tablets used in LATA are a three-drug combination – dolutegravir, tenofovir, plus either lamivudine or emtricitabine.
Researchers will monitor the levels of virus in the participants’ blood approximately every six months. LATA will be the first trial to test this approach in settings where real-time viral load monitoring is carried out less frequently than monthly.
They will also carry out more frequent general health checks, including asking patients about their wellbeing and attitudes towards HIV and their medication.
If the long-acting injectables are as effective as daily tablets, and do not lead to significant side effects, the team hope HIV treatment guidelines could change to recommend long-acting injectables as an option for adolescents.
This could allow young people living with HIV freedom from the lifelong burden of daily medication and relieve anxiety about missing daily doses.
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