Wide range of views about switching to weekly, monthly or biannual ART

Two-thirds of people taking combination antiretroviral therapy (cART) would be interested in switching to a once-weekly oral regimen should it become available, according to American research published in Open Forum Infectious Diseases. Opinion was evenly split on switching to injectable therapy but treatment delivered using implants attracted relatively little interest.

“Forward-looking, patient-centered HIV care will require a great understanding of patient preferences for emerging antiretroviral delivery systems,” comment the authors. “Understanding which patients desire to switch, what the key motivators and perceived benefits are for switching, and ultimately the trade-offs patients are willing to make to effect switches are largely unknown. These data begin to address these issues.”

Promising research is underway that could result in weekly, monthly, even biannual dosing of ART. But the proportion of patients who would prefer these regimens over traditional ART is unclear. Whether there are specific patient characteristics associated with a preference for novel dosing schedules is also unknown.

To answer these questions, investigators in North and South Carolina designed a study involving 263 adult cART-treated people. Recruitment took place between February and August 2017. Participants were presented with the following statement:

“Several new HIV medicines are being developed that could be taken less frequently than currently available options. Compared with your current HIV medicines, how interested would you be in switching to new treatment that…is a single pill once a week, two shots in the clinic every other month, or implanting and removing two plastic rods about the size of matchsticks in each forearm every six months?” Participants were asked to rank their preference on a scale of 1 (not at all interested) to 5 (very interested). 

Study participants had a mean age of 47 years, 56% were male and most (81%) were from a racial or ethnic minority. Over half the sample had a high school education (42%) or less (12%). They had been taking ART for an average of 12 years, with undetectable viral load (below 200 copies/ml) in 82%.

A fifth said they had missed at least one dose of their treatment in the previous two weeks. Current side-effects were reported by a third of participants and 39% said they experienced long-term side-effects.

As regards new therapies, one pill once a week emerged as the clear favourite: 66% said they would be very interested in this option, 20% said they would be somewhat interested and 14% were not at all interested.

Opinions were mixed about injectable therapy: 39% said they were very interested, 23% somewhat interested and 38% not at all interested.

Only 18% of people said they were very interested in implants, 23% were somewhat interested, and a clear majority – 58% – said they were not at all interested in this option.

Higher levels of education were significantly associated with a greater interest in new forms of therapy, especially an injectable (p < 0.001). Younger age (p = 0.036) and experience of long-term side-effects (p = 0.018) were associated with interest in injectables. Being on a one-pill daily regimen was associated with a lower interest in changing to weekly treatment with a single pill (p = 0.046) and implants (p = 0.014).

“Our findings…call attention to the opportunity for providers to build trust with patients by seeking to understand their preferences, communicating risk and benefits clearly, and involving them in shared antiretroviral decision making,” comment the authors.

They suggest that preference for weekly treatment is likely to be because people are already familiar with oral dosing. Opinions regarding more novel forms of administering ART could change as patient awareness of these options increases.

“Interest in longer acting cART delivery systems varies widely among PLWH [people living with HIV],” conclude the investigators. “Understanding preference heterogeneity for these novel treatment modalities may help to inform their development, predict uptake, and inform educational efforts to better engage patients in shared antiretroviral decision making.”