Editor's Note: In recent years, there have been many groundbreaking developments in the prevention and treatment of HIV infections with long-acting formulations. The LATITUDE study on cabotegravir/rilpivirine for patients with poor adherence was reported in the clinical LBA at the CROI conference. Additionally, the conference featured several special sessions discussing how to optimize the use of long-acting formulations. Dr. Charles Flexner from the Johns Hopkins University shared his views on whether long-acting formulations could replace oral medications in an interview with Infectious Disease Frontier.Infectious Disease Frontier: How do you comment the breakthrough of long-acting preparations in the field of HIV in this CROI?
Dr. Charles Flexner: We are learning at this conference that long-acting formulations are enabling individuals who have not been able to suppress their HIV with traditional once-daily oral medications. These long-acting formulations are proving effective in the treatment setting. In prevention, long-acting formulations have been shown to be superior to once-daily oral pills, primarily because adherence to these formulations is significantly better than the requirement to take a pill every day.
Infectious Disease Frontier: What challenges do you think still exist in the promotion and application of HIV long-acting preparations?Could oral preparations be replaced by long-acting in the future?
Dr. Charles Flexner: Oral preparations are likely to be replaced by long-acting formulations in certain contexts, especially in prevention and for patients who cannot maintain viral suppression with daily oral pills. The major challenge lies in scaling up the production of these formulations to make them affordable and accessible not just in high-income countries but also in low and middle-income countries.
Infectious Disease Frontier: What do you think are the important research directions of HIV long-acting preparations in the future?
Dr. Charles Flexner: The development of preparations with longer dosing intervals is crucial. Currently, we have Lenacapavir, a capsid inhibitor administered subcutaneously every six months. Finding a partner drug for Lenacapavir has been challenging. At this meeting, it’s been discussed that Lenacapavir is used in combination with broadly neutralizing monoclonal antibodies. Ideally, we would find other small molecules that could be administered as infrequently as once every six months or even once every twelve months.
Dr. Charles Flexner
Director, AIDS Clinical Trials Unit; Chief Scientific Officer, Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine
