Long-acting injectable HIV drug works for all ages

The long-acting combination of cabotegravir plus rilpivirine, administered as monthly or once-every-2-months jabs, appears to be effective in both older and younger patients living with HIV, with most maintaining virologic suppression through week 96, according to pooled data from the phase III ATLAS, FLAIR, and ATLAS-2M studies.

Virologic outcomes were similar across age groups (<50 vs ≥50 years), with high rates of virologic suppression (87–94 percent), low rates of nonresponse (1–3 percent), and low incidence of confirmed virologic failure (1–2 percent), said Dr Emilie Elliot of ViiV Healthcare, Brentford, United Kingdom, in a presentation at the 24th International AIDS Conference in Montreal, Canada. [AIDS 2022, abstract 4516]

Likewise, safety and tolerability of cabotegravir plus rilpivirine was similar in the <50- and ≥50-year age groups. The frequency of drug-related adverse events (AEs; 21–34 percent), serious AEs (0 to <1 percent), and AEs leading to withdrawal (1–3 percent) were comparable between age groups for both the monthly and once-every-2-months regimens. The most common AEs were headache and fatigue.

“Participants aged <50 and ≥50 years experienced similar types of injection site reactions (ISRs), with injection site pain being the most commonly reported (20 percent of all injections)… Overall, most ISRs were classified as grade 1 (83 percent) or 2 (16 percent),” Elliot noted.

The analysis included 238 patients aged <50 years and 89 who were aged ≥50 years in the once-every-2-months dosing group, and 491 and 119 patients in the monthly dosing group. Most of the population (98–99 percent) received their injections within the 7-day dosing window.

“These data support the use of cabotegravir plus rilpivirine long-acting [injections] dosed monthly or every 2 months as a complete regimen for the maintenance of HIV-1 virologic suppression in adults, irrespective of age,” said Elliot.

“Give it a shot”

Cabotegravir plus rilpivirine long-acting therapy is the first complete HIV treatment regimen that uses a novel antiretroviral delivery method, eliminating the need to take daily pills. It involves two separate injections in the buttocks, administered by a healthcare provider (HCP).

One downside to intramuscular gluteal injection is that it can potentially cause discomfort or pain. This needle-related pain, in turn, can have unwanted consequences, such as vaccine noncompliance and avoidance of essential treatment. [J Adv Nurs 2019;75:30-42]

Another study presented at AIDS 2022 surveyed 181 HCPs from across the long-acting cabotegravir plus rilpivirine development program (North America, Europe, and other regions) to identify the best practices for administering chronic intramuscular injection techniques with the aim of improving patient/provider experience.

“Pushing the injection at a slow speed (66 percent), bringing the medication to room temperature (58 percent), relaxing the gluteal muscle prior to injection (53 percent), and distracting the patient (34 percent) were ranked as the most effective techniques in minimizing pain prior to/during injections,” according to lead investigator Dr Paula Teichner of ViiV Healthcare, Brentford, United Kingdom. [AIDS 2022, abstract 4591]

Meanwhile, over-the-counter pain relievers (74 percent) and returning to routine daily activities (30 percent) were endorsed as the most effective techniques for minimizing postinjection pain. 

Of the HCPs surveyed, the majority were licensed nurses or medical doctors and 46 percent had more than 10 years of experience administering gluteal injections prior to cabotegravir plus rilpivirine study participation.

Overall, one in four HCPs modified their injection technique for patients with a higher body mass index (BMI). Most used a longer needle (ie, 2 inches; 46 out of 47 HCPs), while some used the Z-track technique (11 out of 47 HCPs), positioned the patient differently (two out of 47), and used a different landmarking method to locate the injection site (two out of 47).

“There was no consensus on preference for cabotegravir or rilpivirine to be injected first,” Teichner noted. “The order of drug administration was often dependent on patient and HCP perception of discomfort, preferred order for receiving/administering each drug, room setup, and consistent documentation (eg, rilpivirine on right).”

Taken together, the present data, according to Teichner, reinforce that simple techniques routinely used by HCPs are helpful in optimizing administration of long-acting injectable HIV drugs.