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Considerations for long-acting antiretroviral
therapy in older persons with HIV
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Download the PDF here
dec 2023
".....it is critical to present LAI-ART to the aging population not as a solution to nonadherence but instead as an option to ensure all PWH receive patient-centered treatment."
Conclusion
LAI-ART is a promising therapeutic option for older PWH, which can address issues relating to oral ART adherence and polypharmacy that are common amongst older patients. With the growing number of people aging with HIV, LAI-ART should not just be viewed as a tool for adherence but as an option to ensure all PWH receive patient-centered treatment. To end the HIV epidemic, treatment such as LAI-ART should be broadly and equitably accessible. However, much remains unknown concerning the applicability of LAI-ART among older PWH, as well as unique pharmacological considerations and implementation challenges for this population as few studies have captured older PWH. As the options for LA-ART regimens are expanding, more studies including older PWH are essential to further assess LA-ART effectiveness and safety, and clarify the needs of, and advance health equity for, this growing population.
Abstract
People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.
Introduction
People with HIV (PWH) are now able to enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART) and prevention strategies [1,2]. By 2030, PWH aged 60 years or older are expected to represent over 40% of all PWH globally [3,4], and nearly 25% of all ART users in the United States may be age 65 or older [5]. However, aging with HIV carries unique risks – a higher incidence of health complications and comorbidities compared to older persons without HIV, with resultant polypharmacy and inappropriate prescribing [6–12]. These issues increase the risk of higher pill-burden, drug–drug interactions (DDIs), and toxicities, which may compromise ART adherence and health outcomes [11].
New approaches to drug delivery, such as long-acting formulations, are being developed to strengthen adherence to ART. Long-acting agents in various stages of development include oral therapies (islatravir), implants (tenofovir), microarray patches (rilpivirine), and vaginal rings (dapivirine), as well as long-acting injectable (LAI) injectables like lenacapavir and cabotegravir-rilpivirine (CAB/RPV; Cabenuva), a recently FDA-approved ART given every one to two months for the treatment of HIV infection [13–15]. Though CAB/RPV's novel mode of delivery holds promise in circumventing some of the issues with oral therapy, new challenges and unanswered questions remain, particularly around its use in aging populations. Some studies have explored considerations for LAI-ART acceptability, applicability, and implementation for certain subpopulations [16–20]. However, its benefits, risks, and applications for aging populations and their distinct needs remain understudied. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH.
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