HIV: injections instead of the daily tablet, "a revolution" for some patients

Since the end of December 2021, HIV patients who so wish can, if they meet certain conditions, replace their daily tablet with intramuscular injections to be carried out every two months. “A revolution”, “a real burden less”, testify to France 24 some who have already abandoned their box of pills.

Every day for a year, at 12.30 p.m. sharp, Mathieu*’s telephone rang, signaling the time to take his daily pill. But since February 11, his alarm no longer rings at lunchtime. This 45-year-old Franco-Algerian, who tested positive for HIV in June 2020, is one of the first patients to have replaced his daily medication with a new treatment available in France: intramuscular injections to be carried out every two months. “It’s great! Today, it’s a real relief… it’s priceless,” he told France 24.

This treatment has been reimbursed in France since December 2021, after two years of clinical trials. Specifically, it is the combination of two antiretrovirals, cabotegravir and rilpivirine. Like all viruses, HIV mutates and can therefore develop resistance to certain drugs. To counter this, doctors treat it with tritherapies or dual therapies, that is to say that they mix antiretrovirals in order to better control the replications of the virus.

With this injectable treatment, the method does not change. Except that instead of taking pills daily, patients can go to the hospital every two months and receive a double injection. “Clinical trials have shown that the two treatments are equally effective, it is only the form that changes”, insists to France 24, Bruno Spire, research director at Inserm [institut national de la santé et de la recherche médicale] and honorary president of the Aides association.

“The more treatments, the better,” he says. “It won’t be suitable for all patients, but it can make life easier for others. And that’s the whole point: allowing everyone to find something that suits them.”

Hide your HIV status

Mathieu, he jumped at the chance as soon as it was possible. “I heard about the injection treatment in June 2021. I was immediately ready”, he testifies. “Unfortunately, the set up was slowed down by the Covid-19 pandemic and I was only able to start on February 11.”

His main motivation to end the tablets: to be able to remain more easily discreet about his HIV status. In his entourage, only his sister and his closest friends are aware of his situation. “The first few months, I had a lot of trouble talking about it, I was ashamed. And I’m still afraid of facing serophobia and the lack of knowledge about AIDS,” he explains.

He remembers, for example, the embarrassment he felt when he had to take his medicine in the middle of a lunch with colleagues or friends. “I always had to invent a story. I said that I was taking vitamins because I was tired…”, he says. “It’s all over!”

“AIDS remains something stigmatizing. For some populations, especially in very precarious or migrant situations, HIV is even something very taboo”, also abounds in France 24 Victor Galarraga, activist of the association Aides, who works for access to care for all. “For them, injection treatment could be a real revolution. I know some people who still have to hide their medicine boxes…”

Twenty tablets twenty years ago

Lionel, too, decided to give up the tablets in favor of the injections. The 53-year-old was only 23 when he learned he was HIV-positive. In thirty years, he has witnessed many therapeutic advances in the fight against AIDS. “The first ten years, I did not take care of myself. There were almost no treatments and the rare protocols were very cumbersome”, he recalls, contacted by France 24. “But my condition ended up deteriorating and I no longer had a choice.” The first tritherapies were introduced in 1996.

“At the beginning, I had to take about twenty tablets every day at fixed times. They gave me side effects, such as diarrhea, headaches, fatigue. It was very restrictive,” he says. . “Now I’m being offered simple injections every two months, of course I’m up for it!”

“It’s really revolutionary,” he insists. “Not to mention that with that, we also have peace of mind when traveling. No need to walk around with our medication, to risk being asked unpleasant questions…”

However, not all HIV patients are eligible for this new injection treatment. It can only be administered to people who have had a stable viral load for at least six months. It is also contraindicated in people who have already experienced treatment resistance or treatment failure.

“And some will prefer to stick to tablets,” notes Bruno Spire of Inserm. In a study carried out by his association with 581 people, mostly men (80%) born in France, 48% of respondents say they are very interested and 30% quite interested. “The tablets have a reassuring side. By taking it every day, we have the impression of controlling our disease”, explains Mathieu. “It took me several weeks to remove the alarm on my phone,” he admits, laughing.

Difficulty of access to precarious populations

“The injectable treatment presents another major obstacle: for the moment, you have to go to the hospital to benefit from it”, deplores for his part Victor Galarraga. “For people far from the health system, it is already complicated to go to the pharmacy and to be followed by a doctor, so to go to the hospital…”, he continues. “It’s a shame, because it’s ultimately the public who would certainly need it the most. For us it’s a gain in comfort, for them it could be much more.”

He himself will receive his first injections within ten days. “Every day, taking my medicine, it brings me back to my illness. With the injections, this will no longer be the case,” he testifies.

Faced with this therapeutic advance, Victor, Mathieu and Lionel all cherish the same hope: that this is only an additional step before the implementation of very long-term treatments, or even the arrival of a vaccine. “Maybe soon we will only be able to take a tablet every six months, or have an injection every year,” hopes Mathieu.

“Today, we live very well with HIV, our life expectancy is long and with the injections, our daily life is even lighter”, insists Mathieu. “The real obstacle that persists, and what things really need to change: it is the image that the population has of HIV status. It is the most difficult thing to live with, the gaze of others.”

Bruno Spire at Inserm, for his part, recalls that if treatments progress, we must not forget the importance of screening and protection, in particular via Prep (pre-exposure prophylaxis), preventive treatment against HIV. In France, the number of people currently infected is estimated at 180,000, of whom nearly 25,000 do not know it.

*The name has been changed

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