In The News: Advances in HIV Treatment for Adolescents: Are Long-Acting Injectables the Future?

Healio shares a story on advancements in therapeutic formulations, such as long-acting injectables, in response to concerns that children with HIV aren’t sufficiently adhering to ART treatment. The U.S. Department of Health and Human Services recommends rapid ART initiation following diagnosis for children with HIV regardless of clinical stage or CD4+ (T-cell) count, unless there is an opportunistic infection at diagnosis. There exists, however, a lack of HIV testing and of knowledge among the people aged 13 to 24 that contribute to treatment adherence.

CDC estimates approximately 20% of new HIV cases are in that age group. Yet only 6% of high school students have ever been tested for HIV and almost half in the age group with HIV do not know it. For those who are positive and aware, several obstacles persist in preventing adherence. These factors may include stigma, health insurance, medication reaction, and forgetfulness.

Non- or poor-adherence may lead to resistance developing to one or more components of ART, cross-resistance to other drugs, and greater risk of transmitting the virus. Nonadherence increases with age, according to the U.S. Pediatric HIV/AIDS Cohort Study, partially due to patients aging out of pediatric care. Another issue is the limited availability of once-daily, single-tablet regimens and formulations acceptable to children.

All of this leads to the article’s conclusion that long-acting injectable treatment is the option for adolescents. Cabotegravir and rilpivirine received FDA approval for adults in 2021 and adolescents in 2022. It is the first long-acting injectable HIV treatment. Virologically suppressed adolescents aged 12 years or older who weigh at least 35 kg are eligible for the intramuscular injected treatment. It may be administered monthly or bimonthly.

PIDS member and chair of the Pediatric HIV Interest Group, Rosemary Olivero, commented, “Providers who care for children, adolescents and young adults with HIV have fully embraced long acting injectable antiretrovirals for complete control of HIV in select patients. Adolescents and young adults make up a population that can either struggle with antiretroviral adherence, or simply prefer an injectable option that takes the guesswork out of their HIV management. Pediatric HIV providers welcome this advancement in HIV care, and look forward to when they can offer even more antiretroviral combinations and delivery systems can make HIV treatment as easy, convenient and well tolerated as possible.”