From the end of December 2021, HIV patients who wish to do so will be able, if they meet certain conditions, to replace their daily pill with intramuscular injections every two months. “A revolution”, “a real load less”, tell France 24 some of them, who have already abandoned their box of pills.
Every day for a year, at 12:30 sharp, Mathieu*’s phone rang, marking the time to take his daily pill. But since February 11, his alarm no longer rings at lunchtime. This 45-year-old Franco-Algerian, who tested positive for HIV in June 2020, is one of the first patients to have his daily medication replaced by a new treatment available in France: intramuscular injections every two months. “He’s great! Today, it’s a real relief… priceless,” he told France 24.
This treatment is reimbursed in France from December 2021, after two years of clinical trials. Specifically, it is a combination of two antiretroviral drugs, cabotegravir and rilpivirine. Like all viruses, HIV mutates and can therefore develop resistance to certain drugs. To counteract it, doctors treat it with triple or dual therapies, that is, they mix antiretrovirals to better control the replication of the virus.
With this injectable treatment, the method does not change. Only, instead of taking daily pills, patients can go to the hospital every two months and get a double injection. “Clinical trials have shown that both treatments are equally effective, the only thing that changes is the form,” Bruno Spire, director of research at Inserm (French National Institute of Health and Medical Research) and honorary president, told France 24. of the Aides association.
“The more treatments there are, the better,” he said. “It won’t fit every patient, but it can make life easier for others. And that’s what it’s all about: letting everyone find something that works for them.”
Hide your HIV status
Mathieu seized the opportunity as soon as it was available. “I found out about the injection treatment from June 2021. I immediately jumped on it,” he says. “Unfortunately, the start-up was slowed down by the Covid-19 pandemic and I was not able to start until February 11.”
His main motivation for giving up the pills: to be able to keep his HIV-positive status secret more easily. Only her sister and her closest friends know about her situation. “The first few months it was very difficult for me to talk about it, I was embarrassed. And I’m still afraid of facing serophobia and not knowing about AIDS,” she explains.
Remember, for example, the embarrassment you felt when you had to take your medication in the middle of a meal with co-workers or friends. “He always had to make up a story. He said he took vitamins because he was tired,” he says. “That’s over now!”
“AIDS is still a stigma. For some people, especially those in very precarious situations or immigrants, HIV is even a very taboo subject,” Víctor Galarraga, an activist with the Aides association, who works to ensure access to health care for all. “For them, injection treatment could be a real revolution. I know some people who still have to hide their medicine boxes.”
Twenty tablets twenty years ago
Lionel has also decided to ditch the pills in favor of injections. He was only 23 years old when he found out that he was HIV positive. In 30 years, he has seen many therapeutic advances in the fight against AIDS. “For the first ten years, I did not treat myself. There were hardly any treatments and the rare protocols were very heavy,” he recalls, contacted by France 24. “But my condition ended up deteriorating and I no longer had a choice.” The first triple therapies were introduced in 1996.
“In the beginning, I had to take about 20 pills every day at fixed times. It gave me side effects like diarrhoea, headaches and fatigue. It was very annoying,” he says. “Now they offer me simple injections every two months, of course I’m in!”
“It’s really revolutionary,” he insists. “Not to mention the fact that, with this, you don’t have to worry about traveling. You no longer need to carry your medication with you, risking unpleasant questions.”
However, not all HIV patients are eligible for this new injectable treatment. It can only be given to people who have had a stable viral load for at least six months. It is also contraindicated in people who have already experienced resistance or treatment failure.
“And some prefer to stay with the tablets”, says Bruno Spire, from Inserm. In a study carried out by his association among 581 people, mostly men (80%) born in France, 48% of those surveyed said they were very interested and 30% quite interested. “The pills have a calming side. By taking them every day, you feel in control of your disease,” explains Mathieu. “It took me several weeks to remove the alarm from my phone,” he admits with a laugh.
Difficult access for vulnerable populations
“Another of the main obstacles to injectable treatment is that at the moment you have to go to the hospital to get it,” says Galarraga. “For people who are far from the health system, it’s already complicated to go to the pharmacy and be followed by a doctor, so going to the hospital,” he continues: “it’s a great shame, because these are the people who, without a doubt, most they would need. For us it is a comfort gain, for them it could be much more”.
He himself will receive his first injections in about ten days. “Every day when I take my medication, he brings me back to my illness. With the injections, this will no longer be the case,” he says.
Faced with this therapeutic advance, Victor, Mathieu and Lionel share the same hope: that it is one more step before the introduction of very long-term treatments, or even the arrival of a vaccine. “Maybe soon we will only be able to take a pill every six months, or get an injection every year,” Mathieu hopes.
“Today, we live very well with HIV, our life expectancy is long and, with the injections, our day-to-day life is even lighter,” insists Mathieu. “The real obstacle that persists, and what really needs to be changed, is the image that people have of being HIV positive. It is the most difficult thing to live with, the gaze of others.”
For his part, Bruno Spire, from Inserm, recalls that, although treatments are advancing, we must not forget the importance of detection and protection, especially through Prep (pre-exposure prophylaxis), the HIV prevention treatment. In France, it is estimated that there are currently 180,000 infected people, of which almost 25,000 do not know it.
*Name has been changed
*Article adapted from its original in French
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