World AIDS Day: Are long-acting HIV therapies the future?

Professor Andrew Owen and Professor Steve Rannard are co-directors of our Centre of Excellence for Long-acting Therapeutics. For this year’s World Aids Day, they sat down for a wide-ranging chat about their pioneering work to transform the future of HIV treatment.

What is your research in a nutshell?

Andrew: “We’ve focused on taking drugs already used for the treatment of HIlongV, which require daily taking of pills by patients, and transforming them through various technologies into drugs, which can be administered for much longer periods of time - typically once every month or even longer than that.”

 What’s the benefit for patients?

Steve: “HIV is a lifelong commitment to therapy. Patients are required to take tablets every day for the rest of their life and this is not an easy request to make. Anything that can be done to minimize this burden could be life changing.

"Changing the way HIV are drugs are administered will also benefit infected children, especially the very young that can't easily be given tablets. Part of our work is focusing on ways to administer poorly soluble but highly efficacious drugs to children."

Andrew: “Also in some areas of the world, the taking of tablets, particularly for HIV, is very stigmatizing. So a long-acting injectable, for example, is very effective method of drug delivery which is compatible with health care privacy as well, which is extremely important.”

What about drug resistance?

Andrew: “When patients skip a dose of the drug, the drug concentrations within the body dip below those concentrations required to inhibit viral replication. That gives an opportunity to the virus to adapt to the drug. If this happens too frequently, the virus will become resistant to the drug.

"If we can remove the necessity for the patient to take drugs daily, they don’t need to be reminded all the time of their disease, they don't need to take tablets every morning, and there's less opportunity for the virus to escape and form resistance to the drug. This is a huge benefit."

Could they help improve access to treatment?

Steve: “When medicines are taken orally, only a fraction of the drug enters the bloodstream and ends up at the point of need; much is simply not absorbed and is wasted with no benefit. If the amount of drug that enters the bloodstream can be optimised by using long-acting therapies, it is possible that more patients can benefit from the available supply.

"Long-acting administration of drugs may mean that we could decrease the amount of drug needed per patient, reducing the cost and offering more therapy to more people globally. This would have real impact in low and middle income countries and would help to increase access to drugs for those who desperately need them."

Are long-acting therapeutics the future of HIV treatment?

Steve: “We are highly convinced that long-acting therapeutics have a considerable role to play. We also believe that long-acting therapeutics are probably the future for a lot of different diseases, but the benefits are already being made available in HIV treatment.”

Andrew: “The first long-acting injectable was approved last year by the EMA and this year by the FDA. There's a lot of community engagement activities which have been conducted, with patients and providers in order to understand what their preferences are. These have overwhelmingly suggested that this is what patients want, because it simplifies therapy and they no longer have to worry about taking tablets on a daily basis.

"I'm confident we'll see a lot more long-acting therapeutics being developed in the coming years."

Visit our Research website to read the full interview with Andrew and Steve.

World AIDS Day takes place on 1 December each year. It’s an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Founded in 1988, World AIDS Day was the first ever global health day.

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