The treatment of human immunodeficiency virus (HIV) has been revolutionary for the 20th and 21st century HIV patients. In the 1990s, patients who were diagnosed with HIV essentially had a death sentence given to them. Patients with HIV who develop a CD4 count less than 200 are diagnosed with acquired immunodeficiency syndrome (AIDS). Patients with AIDS are at risk for many different opportunistic infections. Patients with HIV and AIDS often do not die from the infection itself, but rather from the opportunistic infections that develop as a result of a low CD4 count. (1) During the 1980s, many patients were dying from this disease that was not well-known. There was not much information about where the disease came from, how it spread from person to person, and there was certainly no approved medications. In March 1987, the first antiretroviral medication was approved. Zidovudine was the first HIV medication on the market, and it changed how patients were treated. This disease no longer became one of supportive care. Although many people still died after the introduction of this therapy, it led to the rise of more clinical trials and more approved therapies. In 1990, zidovudine was approved for use in children who had been introduced to the virus through their mothers or through other means. During this time, many patients with hemophilia received blood contaminated with the HIV virus. In June of 1995, the first protease inhibitor was approved, thus initiating the HAART treatment. HAART is a combination approach using multiple HIV medications to treat the disease.(2)
The Food and Drug Administration approved the use of Cabenuva and Vocabria together for the treatment of HIV. Cabenuva is an extended-release injectable suspension that is administered once monthly. Before a patient is initiated on a treatment of Cabenuva, there is an initial regimen of oral cabotegravir. The patient will take the oral version of Cabenuva in order to ensure tolerability of therapy. After the patient tolerates the oral formulation, they will be switched to the injectable formulation. This new formulation and dosing regimen for the treatment of HIV is revolutionary. HIV is now a controllable disease, as there are so many medications and regimens on the market. The caveat to these treatments, however, is that adherence is essential for suppressing viral load and preventing CD4 depletion. Patients with HIV who are not adherent to their medications are still susceptible to the same effects as patients in the 1980s who had no available treatment. Patients with difficulty adhering to treatment regimens should be evaluated for treatment with Cabenuva and Vocabria. Once monthly intramuscular injections are much more tolerable for patients than taking anywhere from one to three pills daily.(3)
One of the issues to these new treatment regimens is, of course, cost. HIV medications are notorious for being expensive medications. Adherence is a matter of public health, and there are many programs and affiliations that allow patients access to these medications with no copay, even if they do not have any prescription coverage. It will be quite interesting to see how this issue develops over the next few months as this treatment is adopted into practice.
Volberding PA. HIV Treatment and Prevention: An Overview of Recommendations From the IAS-USA Antiretroviral Guidelines Panel. Top Antivir Med. 2017;25(1):17-24.
History of HIV and AIDS overview. Avert. https://www.avert.org/professionals/history-hiv-aids/overview. Published October 10, 2019. Accessed December 16, 2021.