HIV antiretroviral therapy has changed and improved dramatically since it first became available, said Jana K. Dickter, MD, associate clinical professor, Division of Infectious Diseases, City of Hope.
Jana K. Dickter, MD, associate clinical professor, Division of Infectious Diseases, City of Hope, talks about how HIV treatment and management has evolved, especially in the past 2 decades.
How has the HIV treatment and management space evolved over the past 20 years, and how is it expected to change going forward?
Antiretroviral therapy has changed and improved dramatically since its inception. In the early days, in the late 80s and early 90s, only 1 class of medications were available and the early drugs had a number of adverse effects and resistance developed when these medications were used as individual agents. In the mid 1990s, new classes of drugs were introduced, and study showed that combination treatment was effective in controlling viral replication. This became the standard for treatment by 1997 and, consequently, deaths due to HIV and AIDS dropped precipitously in the following years in countries where these medications were available.
Since then, HIV has become a chronic illness for many people, and today there are 8 different classes of medications available. Many of the pills today are combination pills, so people living with HIV can take fewer pills per day and they're better tolerated in general compared to many of the older medications. It's important for people to take their medications every day because, if they don't, that's how drug resistance can develop and, over time, HIV treatment failure. And this can lead to people developing a decrease in the function of their immune systems, which is in turn associated with opportunistic infections and certain types of other comorbidities, including cardiovascular disease, neurologic disease, and cancer.
What's new in the area of treatment is the idea of injectable medications, which could be active for weeks to months. Many patients don't like having to take a medication every day; sometimes they don't like to be reminded psychologically that they have HIV on a daily basis. In terms of the long-term injectables, there is currently 1 combination medication available that some patients are only receiving an injection for now every 2 months.
But what's exciting is that there are other medications that are currently under investigation that may require injections even less frequently, perhaps every 6 months or even once a year, and this would be a big change in treatment for people living with HIV.