Long-acting HIV treatments move a step closer

A decision from the Scottish Medicines Consortium means that people in Scotland living with HIV could soon have the option of swapping daily pills for bi-monthly injections to manage their condition.

The landmark decision paves the way for Scotland to become the first part of the UK to make long-lasting injectable HIV treatments widely available.

We warmly welcome this decision which will widen the range of HIV treatment options available, ensuring that people living with HIV can find the treatment that works for them.

Here we take a look at decision, how it was made, and what it could mean for people living with HIV.

What has happened? 

At its most recent meeting, the Scottish Medicines Consortium (SMC) agreed that two new HIV drugs, cabotegravir and rilpivirine, should be accepted as a treatment option for adults living with HIV. 

The SMC is responsible for providing advice to NHS Scotland about whether new medications should be made available to patients. 

It bases its decisions on things like how effective a new medicine is, how affordable it will be for the NHS and how it could benefit patients. 

What are cabotegravir and rilpivirine? 

Cabotegravir and rilpivirine are injections that can be used together for the treatment of HIV in adults.    

They work in a similar way to the existing HIV treatments, but are released far more slowly into the bloodstream, meaning they need to be taken less regularly. 

People living with HIV who are prescribed these new treatments will be able to swap daily pills for two injections once every two months. 

Trials have shown the drugs to be similarly effective to daily HIV treatments.  

What are the benefits of the new treatments? 

Ahead of the SMCs decision, we were invited to submit a Patient Group Submission – where we could share the views of service users about the new treatment.  

We carried out a small survey, which highlighted a number of potential benefits of long-acting treatment options, including: 

• Making it easier for people to adhere to treatment, and therefore to manage their HIV 
• Providing a more private and subtle alternative to daily medication, reducing the risk of stigma and discrimination based on HIV status 
• Providing a more accessible option for people who are homeless, who can struggle to access prescriptions 
• Providing a more practical option for people who struggle to swallow tablets due to dysphagia 
• Removing the link between medication and diet (e.g. the need to take pills on a full stomach)  

In addition to these benefits, we highlighted that increasing the range of treatment options available benefits patients, by allowing them to work with their doctors to find an option that works for them and that allows them to have a better quality of life. 

 You can read our Patient Group Submission here. 

Who should be able to access the new treatments? 

The SMC has recommended that these new treatments should be made available to people living with HIV who have reached an undetectable viral load.  

Undetectable means that the levels of HIV in the blood are so low that it cannot be transmitted to sexual partners (this is often referred to as Undetectable=Untransmittable, or U=U). This is something that can be checked as part of a person’s regular appointments with their HIV clinic. 

Before starting injections, people would be asked to take a one-month course of the same drugs in tablet form to check for potential side effects.   

Provided they respond well to the oral medication, they would then receive treatment as two separate injections at the same visit to a clinic, once every two months.  

If someone was due to miss an appointment, they could be prescribed tablet forms of the drugs as a short-term option.  

Are the new treatments available right away? 

In a word no. But the SMC decision moves us a big step closer. 

Now that the new drugs have been approved for use on the NHS in Scotland, each local NHS board can decide how it will make the medication available. 

We are writing to each of the 14 health boards in Scotland to urge them to approve these medications for use as soon as possible.