HIV: is a life-changing formulation in the pipeline?

Posted 11 January 2018 in Men's Health, Sexual Health, Womens health

Daily Pills. Picture courtesy of pixabay.comHIV (human immunodeficiency virus) is no longer the death sentence it once was, thanks to the development of numerous tests and treatments over the years. However, the cocktail of drugs that those diagnosed with HIV must take daily, just to keep the virus at a low enough level to maintain a functional immune system, could be considered a life sentence. Understandably, a way to reduce this frequency of dosing is greatly desired – and recent research shows that in the future it may become reality. (1)

HIV is primarily a sexually transmitted infection, but it may also be passed from one person to another via sharing needles or sex toys, accidentally pricking oneself with a contaminated needle or via blood transfusion. It can also be passed to a baby during birth or breastfeeding if the mother is infected. People at greatest risk include homosexual men, heterosexual black African people of any gender, and anyone who shares needles or syringes with others. (2, 3)

Once HIV has found its way into the body, it hijacks specific cells in the immune system known as CD4 lymphocytes, forcing them to abandon their intended function and instead produce thousands more copies of the virus. The CD4 cells then die, releasing the newly made viruses, which go on to repeat the process again and again over a timespan of up to 10 years until CD4 levels are critically low and the immune system fails. (2)

If HIV is diagnosed early, a course of HIV medication known as post-exposure prophylaxis (PEP) can prevent the virus from taking hold, as long as it is taken within three days of first contact with the virus. If this is unsuccessful, or more than three days have elapsed, medication will need to be started as soon as possible to keep the virus under control. (2)

There is a wide range of HIV medication, also known as antiretroviral medication, available and people with HIV must take a combination of medicines daily to halt the progression of the disease and maintain health. Antiretrovirals are grouped into the following categories:

  • nucleoside reverse transcriptase inhibitors (NRTIs), which include zidovudine, abacavir and lamuvidine, and work by preventing the virus’s genetic material from being copied

  • non-nucleoside reverse transcriptase inhibitors (NNRTIs), including efavirenz, etravirine and rilpivirine, which work in the same way as NRTIs

  • protease inhibitors, such as ritonavir, saquinavir and atazanavir, which prevent formation of new copies of the virus

  • integrase inhibitors, including dolutegravir and raltegravir, which prevent the hijacking of CD4 cells by the virus. (4)

Other antiretroviral medications outside these categories include enfuvirtide and maraviroc, which work in different ways to the medications listed above. (4)

The promising news

Recent research by the Massachusetts Institute of Technology has demonstrated that in the future it may be possible to reduce the frequency of HIV medication dosing from daily to weekly by adopting a new formulation. Pigs were administered various drugs in the form of a capsule containing a star-shaped structure, which broke down much more slowly than a tablet or standard capsule, releasing the medicine gradually over as long as two weeks. Biotechnology company Lyndra is now planning to bring this success forward to human trials over the next year. Such a formulation would be life-changing for millions of people worldwide, making it easier to remember to take medication as well as freeing them of the inconvenience of taking numerous drugs daily. It is too early to know how long it may be before weekly HIV medication becomes mainstream, but this is very exciting news indeed. (1)

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References

  1. BBC News (2018). ‘Once-a-week pill for HIV shows promise in animals’. Available at: http://www.bbc.co.uk/news/health-42610315

  2. NHS Choices. Causes [cited 9 January 2018]. Available at: https://www.nhs.uk/conditions/hiv-and-aids/causes/

  3. NHS Choices. Overview [cited 9 January 2018]. Available at: https://www.nhs.uk/conditions/hiv-and-aids/#causes-of-hiv-infection

  4. British National Formulary (version 4.2) [Mobile application software]. Retrieved from: www.bnf.org

    Author: Gabby Gallagher MPharm

    Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/01/18

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 11/01/18

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