Tag: 上海419龙凤JZ

Posted in votwpslwaksb

Swapping daily pills for monthly shots could transform HIV treatment and prevention

first_imgIn a clinical trial in Mfekayi, South Africa, counselors counted antiretroviral pills to make sure participants took medications as directed. Click to view the privacy policy. Required fields are indicated by an asterisk (*) Swapping daily pills for monthly shots could transform HIV treatment and prevention By Jon CohenAug. 22, 2018 , 11:30 AM Sign up for our daily newsletter Get more great content like this delivered right to you! Country Emailcenter_img New results are raising hopes for easing one challenge of living with HIV: the need to take daily pills for life, both to ward off AIDS and to lower the risk of transmitting the virus to others. Missing doses can also foster the emergence of HIV strains with drug resistance, a danger both to the person receiving treatment and, if those strains spread, to entire populations. Now, a large-scale study has shown over 48 weeks that monthly injections of two long-acting anti-HIV drugs work just as well as taking daily pills.ViiV Healthcare, a London-based collaboration between GlaxoSmithKline and Pfizer, revealed the highly anticipated findings in a press release on 15 August. This shareholder announcement, required by regulatory agencies to inform investors, offered scant data. But it was welcome news to other researchers studying long-acting anti-HIV medication schemes—and to clinicians who think they could transform both treatment and prevention of HIV infections.Anton Pozniak, an HIV/AIDS clinician at Chelsea and Westminster Hospital in London, says long-acting injections could help HIV-infected people who have “pill fatigue,” difficulty swallowing the medication, or psychological issues that make it hard to cope with a daily reminder that they have a deadly virus. He calls the results “a fantastic development” but adds, “We still have a way to go.” Even if these injectables win regulatory approval, many practical questions remain about their cost, the impact of missing shots, inflammation at injection sites, and the burden on health care systems of providing monthly intramuscular injections. Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe J. Cohen/Science The phase III study, called Antiretroviral Therapy as Long-Acting Suppression (ATLAS), is testing an experimental drug, cabotegravir, made by ViiV, and rilpivirine, a licensed medicine from Janssen Sciences Ireland UC in Dublin, in 618 HIV-infected people from 13 countries. All had fully suppressed the virus for at least 6 months with oral drugs. Half stayed on daily pills, while the others received an injection into the buttocks of each drug once a month. Viral suppression was the same in both groups, ViiV’s statement says.Kimberly Smith, who heads R&D for ViiV from Durham, North Carolina, says the injectables could make it easier for clinicians to know for certain that patients are adhering to their treatment. Studies have shown that about 30% of HIV-infected people have difficulty doing so at some point; even those taking just a single multidrug pill a day miss doses. Smith, an HIV/AIDS clinician before she came to ViiV, says, “I experienced having patients die … because they just couldn’t get over that hurdle of taking that pill every day.”Long-duration anti-HIV drugs could also protect uninfected people at risk of getting the virus. Such people are even more reluctant to take daily pills, as required for so called pre-exposure prophylaxis (PrEP). Raphael Landovitz, a clinician at the University of California, Los Angeles, who studies long-acting drugs for PrEP, says the ATLAS data are “incredibly encouraging and exciting” and are “certainly reassuring” to people doing similar prevention work.Landovitz is collaborating on studies of how long-acting injectables, including cabotegravir and, separately, a monoclonal antibody developed by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, improve adherence in people on PrEP. Also underway is a phase III study of the ATLAS regimen in HIV-infected people who have never taken any antiretrovirals. It addresses the possibility that patients in the original trial, who were on oral drugs beforehand, might harbor resistant virus that could undermine the effectiveness of the injections. And a trial called ATLAS 2 will ask whether the injectables can effectively suppress HIV if given only once every 8 weeks.Other long-acting HIV treatments at earlier phases of clinical testing include injections of a new Gilead Sciences drug that cripples the making of HIV’s capsid protein, a novel target. Researchers also are exploring long-acting alternatives to injections, including a Merck & Co. pill that inhibits HIV’s reverse transcriptase enzyme for up to 10 days. In the future, researchers hope to extend the effect of antiretrovirals with slow-release skin implants or polymer-based pills that slowly dissolve in the stomach.If both phase III studied have positive results, the drugmakers could apply for regulatory approval next year. But Landovitz cautions that many “nuanced questions” remain about how to use these long-acting drugs. What’s the optimal dose and timing of injections? What resistance mutations might emerge and how would they hamper the effectiveness of conventional oral drugs?Although a long-acting drug regimen can be a blessing, Smith says, “it has the potential to be a curse if a person disappears.” Because the drugs metabolize so slowly, they can have an unusually long pharmacological “tail,” their presence steadily declining in blood and tissues for a year or longer, which could allow drug-resistant strains of HIV to flourish.It’s anyone’s guess what the long-acting drugs would cost and whether developing countries could afford them. It’s also unclear how many people will opt for injections over pills. So only real-world experience will prove whether long-acting interventions will be “a niche or transformative,” Landovitz says. As NIAID head Anthony Fauci puts it, “This is not the end game, but it’s an important first step.”last_img read more

Continue Reading Swapping daily pills for monthly shots could transform HIV treatment and prevention