Redefining Options: How Long-Acting Injectables Are Reshaping HIV Treatment and Prevention

While scientific progress has helped to transform an HIV diagnosis from a once-fatal condition into a manageable chronic one, the epidemic is far from over, and there is still work to be done. Kimberley Brown, PharmD, Head of US Medical Affairs at ViiV Healthcare, believes that HIV research and innovation should continue to be informed by the needs of the community and include more shared decision-making regarding the available options for HIV treatment and prevention.

In an interview with Infection Control Today^® (ICT^®), Brown described how ViiV Healthcare's position as the only pharmaceutical company solely focused on HIV shapes its approach to research and development, the impact of long-acting injectables in the HIV treatment and prevention landscape, and the critical role health care professional-patient conversations have in identifying a personalized care plan that fits each person’s clinical needs, preferences and goals.

A Singular Focus on HIV

ViiV’s mission is to leave no person living with HIV behind. “Having that singular focus shapes everything that we do and how we work,” Brown said.

ViiV Healthcare partners with the community to address HIV-related challenges, advocate for and support those who are most impacted by HIV. “The progress we’ve seen has the greatest impact when it’s informed by the people who it’s intended to serve and not just done in a vacuum,” Brown said.

Guided by the voices of patients and insights from community partners, ViiV Healthcare has pioneered new and innovative options, from the first antiretroviral medicine for HIV treatment in the 1980s to the first second-generation integrase strand transfer inhibitors, which have become a standard component of HIV regimens worldwide. They also developed the first 2-drug regimen for daily oral HIV treatment and the first long-acting injectables for treatment and prevention, which address key unmet needs within the community.

A Personalized Approach to HIV Care

When it comes to HIV treatment and prevention, Brown notes, “There’s no one-size-fits-all type of solution. The way I think about care today is really from a shared decision-making model.” She described that model as a partnership in which the provider and the person living with HIV, or someone who may benefit from preexposure prophylaxis (PrEP) for HIV prevention, discuss all available therapies and determine an appropriate care plan together.

This approach to care should consider more than clinical measures alone. The evolution of HIV therapy has changed how health care providers can think about successful long-term care. For people living with HIV, clinical measures such as viral suppression and CD4 count are imperative laboratory markers, but they do not capture every aspect of a person’s experience with therapy. For people who could benefit from PrEP, shared decision-making should likewise consider the clinical profile of available prevention options alongside individual preferences, including factors such as dosing frequency and the route and site of administration. “It can’t just be that laboratory marker because we have to look at the entire patient,” Brown said.

Additional factors such as adherence, discretion, and how a treatment or prevention option fits into a person’s life are important considerations for health care providers and patients to discuss together as part of shared decision-making. For many people, daily oral pill regimens for HIV treatment or prevention can present real-world challenges, including pill fatigue, privacy concerns, or fear of disclosure related to HIV stigma. Long-acting injectables offer an alternative to daily oral dosing and can help address these concerns. “We have to have a variety of options to meet the different needs of different people,” Brown said. The goal is not to position one approach as universally preferable, she explained, but to offer meaningful options that support clinical needs while also reflecting individual preferences and circumstances.

Brown encouraged clinicians to make space for these critical conversations. Asking open-ended questions, such as “Is there anything you would like to be different about your experience with your HIV treatment or prevention therapy?” can help deepen the dialogue with patients. “You don’t really know unless you ask,” Brown said. These conversations can help providers better understand a person’s goals and experience with care and, through shared decision-making, determine whether a long-acting injectable option may be appropriate for them.

Where HIV Innovation Goes Next

For Brown, the pace of innovation in HIV care is a reason for optimism. She began practicing in an era when HIV treatment commonly meant taking dozens of pills each day; today, health care providers and patients can consider a far broader range of treatment and prevention approaches, with additional innovations on the horizon.

Brown said ViiV Healthcare is excited to explore even longer-acting approaches to care and provide different options for people living with HIV and people who are interested in or could benefit from PrEP.

Brown emphasized that continued progress would depend on listening to the people and communities affected by HIV as innovation moves forward. “You can drive the scientific advancement, but if you don’t have that partnership, and if you’re not listening to the community, it’s really all for naught,” Brown said.

For ViiV Healthcare, that work continues to guide its purpose of getting ahead of HIV together and its ambition of ending the HIV and AIDS epidemic for everyone