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French Studies Find Eagerness for Long-Term
Injectables--With Key Cautions
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17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Two surveys conducted in and around Paris found that three quarters or more respondents said they would use long-acting injectable antiretrovirals (ARVs) for treatment or pre-exposure prophylaxis (PrEP) [1,2]. But in one study HIV-positive people younger than 55 proved 2 to 3 times more likely than older people to give injectables a thumbs-up [1], while the other study found injectables more popular among PrEP users than among people with HIV.
In November-December 2017, researchers at Delafontaine Hospital in St. Denis, near Paris, conducted a cross-sectional single-center study of HIV-positive people who took long-acting injectable antiretroviral therapy (ART) in a clinical trial. All were adults currently taking oral ART with an undetectable viral load. Among the 304 participants, 197 (65%) were women, 252 (83%) were nonwhite, 109 (36%) were 50 or older, and median age stood at 46. Two thirds of the group had HIV infection for 10 or more years, and 46% took a single-tablet regimen.
Before participating in a trial of long-acting injectables, only 42% had heard of that form of treatment. But 64% said they would try once-monthly injectable therapy, and 76% would try an every-2-month injection. Compared with 55 people who were 55 or older, 249 younger participants proved twice as likely to favor injections if given once a month (odds ratio 2.07, 95% confidence interval [CI] 1.59 to 2.7, P = 0.01) and more than 3 times more likely to favor injections if given every 2 months (odds ratio 3.69, 95% CI 2.73 to 5, P = 0.03).
Among 152 people asked why they preferred injections to oral ART, 112 (74%) cited greater convenience, 58 (38%) noted lower fear of forgetting a dose, and 18 (12%) pointed to greater confidentiality.
The second study, conducted at centers within or outside Paris, enrolled people with good HIV control on ART or HIV-negative people who had taken oral tenofovir/emtricitabine PrEP for at least 6 months. Between October and December 2018, the researchers enrolled 100 people with HIV and 100 people on PrEP. People with HIV were older (median age 50 versus 39) and had higher rates of comorbidities. All PrEP users were men, compared with about 75% of people with HIV.
A self-administered questionnaire indicated that 49% of people with HIV versus 70% of PrEP users would accept a once-monthly long-acting injectable, but that difference lacked statistical significance. While 70% with HIV would accept an injection every other month, 89% of PrEP users would accept that frequency, a highly significant difference (P = 0.001).
People with HIV differed significantly from PrEP users in perceived advantages of a long-acting injectable: being certain not to forget treatment (39% versus 68%, P < 0.0001), hiding treatment (0% versus 7%, P = 0.014), no need to think about treatment every day (28% versus 62%, P < 0.0001), and forgetting their disease (19% versus 0%, P < 0.0001). Perceived drawbacks of injectables also differed between people with HIV and the PrEP group: loss of freedom (6% versus 30%, P < 0.0001), misgivings about adverse effects (29% versus 47%, P = 0.013), already taking other treatments (7% versus 1%, P = 0.065), and too much of a constraint (21% versus 0%, P < 0.0001).
Multiple correspondence analysis suggested greater acceptance of long-acting injectables by people with HIV and PrEP users who had no treated comorbidities, were not alcoholic or a drug addict, and did not smoke.
References
1. Khuong-Josses MA, Charpentier C, Sayre N, Buson M, Poupard M. Will HIV-infected patients taking oral ARV switch to long-acting injectable ART when it becomes available? 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PE30/3.
2. Slama L, Porcher R, Chakvetadze C, et al. Injectable long acting antiretrovirals for HIV treatment or prevention: the ANRS CLAPT study. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PE30/9.
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