Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series
Abstract Background Adherence to antiretroviral treatment (ART) remains the cornerstone of optimal HIV outcomes, including viral suppression (VS), immune recovery, and decreased transmission risk. For many people with HIV (PWH), particularly those with early-acquired HIV, structural, behavioral, and...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12981-022-00477-w |
| _version_ | 1828096955398488064 |
|---|---|
| author | Christin Kilcrease Hasiya Yusuf Joan Park Aaron Powell Leon James RN Jacob Oates RN Brittany Davis LMSW Ethel D. Weld Kelly E. Dooley Renata Arrington-Sanders Allison L. Agwu |
| author_facet | Christin Kilcrease Hasiya Yusuf Joan Park Aaron Powell Leon James RN Jacob Oates RN Brittany Davis LMSW Ethel D. Weld Kelly E. Dooley Renata Arrington-Sanders Allison L. Agwu |
| author_sort | Christin Kilcrease |
| collection | DOAJ |
| description | Abstract Background Adherence to antiretroviral treatment (ART) remains the cornerstone of optimal HIV outcomes, including viral suppression (VS), immune recovery, and decreased transmission risk. For many people with HIV (PWH), particularly those with early-acquired HIV, structural, behavioral, and cognitive barriers to adherence and competing priorities related to life events may be difficult to overcome, resulting in nonadherence. Long-acting injectable antiretroviral therapies (LAI-ART) may be a useful strategy to overcome some of these barriers. However, to date, the approved LAI-ART strategies (e.g., cabotegravir and rilpivirine (CAB/RPV)) have targeted those who have already attained viral suppression, precluding their use in the 40% of adolescents and young adults (AYA) that VS has eluded. Case presentation Ms. X is a 30-year-old woman with perinatally-acquired HIV and barriers to adherence. Despite many interventions, she remained persistently viremic, with resultant immune suppression and multiple comorbid opportunistic conditions, and viral load (VL) > 10,000,000 copies/ml. Given her longstanding history of poor adherence to an oral regimen, a switch to monthly intramuscular (IM) injections and biweekly infusions of ibalizumab were initiated leading to decreased viral load to 8,110 copies/ml within two weeks. Ms. H is a 33-year-old woman with cognitive limitations due to childhood lead poisoning. Her viral load trajectory took a downward turn, precipitated by various life events, remaining elevated despite intensive case management. Initiation of LAI-ART (CAB/RPV) in this patient led to an undetectable VL (< 20 copies/ml) within two months of treatment initiation. Miss Y. is a 37-year-old woman with perinatally-acquired HIV and chronic challenges with nonadherence and longstanding immunosuppression with CD4 < 200 cells/mm3 for > 5 years. She received a 1-month oral lead-in (OLI) of cabotegravir/rilpivirine, followed by the injectable loading dose. She has since adhered to all her monthly dosing appointments, sustained VS, and transitioned to a bi-monthly injection schedule. Conclusion These three individuals with HIV (perinatally and non-perinatally acquired) with longstanding nonadherence and persistent viremia were successfully initiated on LAI-ART through the process of care coordination and the collective efforts of the care team, highlighting the barriers, challenges, and the multidisciplinary coordination needed to assure successful implementation of this strategy for the most vulnerable of patients. |
| first_indexed | 2024-04-11T07:38:28Z |
| format | Article |
| id | doaj.art-569baf4cde0b481c93db7f2d7b7231cb |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-04-11T07:38:28Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-569baf4cde0b481c93db7f2d7b7231cb2022-12-22T04:36:39ZengBMCAIDS Research and Therapy1742-64052022-11-011911610.1186/s12981-022-00477-wRealizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case seriesChristin Kilcrease0Hasiya Yusuf1Joan Park2Aaron Powell3Leon James RN4Jacob Oates RN5Brittany Davis LMSW6Ethel D. Weld7Kelly E. Dooley8Renata Arrington-Sanders9Allison L. Agwu10Department of Clinical Pharmacy, Johns Hopkins HospitalDepartment of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins School of MedicineDepartment of Pediatrics, Division of General Pediatrics, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineDepartment of Medicine, Vanderbilt University Medical Center7Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins School of MedicineDepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of MedicineAbstract Background Adherence to antiretroviral treatment (ART) remains the cornerstone of optimal HIV outcomes, including viral suppression (VS), immune recovery, and decreased transmission risk. For many people with HIV (PWH), particularly those with early-acquired HIV, structural, behavioral, and cognitive barriers to adherence and competing priorities related to life events may be difficult to overcome, resulting in nonadherence. Long-acting injectable antiretroviral therapies (LAI-ART) may be a useful strategy to overcome some of these barriers. However, to date, the approved LAI-ART strategies (e.g., cabotegravir and rilpivirine (CAB/RPV)) have targeted those who have already attained viral suppression, precluding their use in the 40% of adolescents and young adults (AYA) that VS has eluded. Case presentation Ms. X is a 30-year-old woman with perinatally-acquired HIV and barriers to adherence. Despite many interventions, she remained persistently viremic, with resultant immune suppression and multiple comorbid opportunistic conditions, and viral load (VL) > 10,000,000 copies/ml. Given her longstanding history of poor adherence to an oral regimen, a switch to monthly intramuscular (IM) injections and biweekly infusions of ibalizumab were initiated leading to decreased viral load to 8,110 copies/ml within two weeks. Ms. H is a 33-year-old woman with cognitive limitations due to childhood lead poisoning. Her viral load trajectory took a downward turn, precipitated by various life events, remaining elevated despite intensive case management. Initiation of LAI-ART (CAB/RPV) in this patient led to an undetectable VL (< 20 copies/ml) within two months of treatment initiation. Miss Y. is a 37-year-old woman with perinatally-acquired HIV and chronic challenges with nonadherence and longstanding immunosuppression with CD4 < 200 cells/mm3 for > 5 years. She received a 1-month oral lead-in (OLI) of cabotegravir/rilpivirine, followed by the injectable loading dose. She has since adhered to all her monthly dosing appointments, sustained VS, and transitioned to a bi-monthly injection schedule. Conclusion These three individuals with HIV (perinatally and non-perinatally acquired) with longstanding nonadherence and persistent viremia were successfully initiated on LAI-ART through the process of care coordination and the collective efforts of the care team, highlighting the barriers, challenges, and the multidisciplinary coordination needed to assure successful implementation of this strategy for the most vulnerable of patients.https://doi.org/10.1186/s12981-022-00477-wInjectable antiretroviralNonadherenceOutcomesHIV/AIDSCare coordinationLong-acting |
| spellingShingle | Christin Kilcrease Hasiya Yusuf Joan Park Aaron Powell Leon James RN Jacob Oates RN Brittany Davis LMSW Ethel D. Weld Kelly E. Dooley Renata Arrington-Sanders Allison L. Agwu Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series AIDS Research and Therapy Injectable antiretroviral Nonadherence Outcomes HIV/AIDS Care coordination Long-acting |
| title | Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series |
| title_full | Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series |
| title_fullStr | Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series |
| title_full_unstemmed | Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series |
| title_short | Realizing the promise of long-acting antiretroviral treatment strategies for individuals with HIV and adherence challenges: an illustrative case series |
| title_sort | realizing the promise of long acting antiretroviral treatment strategies for individuals with hiv and adherence challenges an illustrative case series |
| topic | Injectable antiretroviral Nonadherence Outcomes HIV/AIDS Care coordination Long-acting |
| url | https://doi.org/10.1186/s12981-022-00477-w |
| work_keys_str_mv | AT christinkilcrease realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT hasiyayusuf realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT joanpark realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT aaronpowell realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT leonjamesrn realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT jacoboatesrn realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT brittanydavislmsw realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT etheldweld realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT kellyedooley realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT renataarringtonsanders realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries AT allisonlagwu realizingthepromiseoflongactingantiretroviraltreatmentstrategiesforindividualswithhivandadherencechallengesanillustrativecaseseries |