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Dr Conway's intervention at the News Conference on the Long-Acting Injectable Campaign
from AIDS Vancouver
“BC is being asked to join the rest of Canada in this new era of injectable antiviral therapy. Let us do the right thing for the men and women living with HIV in BC”
Dr Brian Conway, on Long-Acting Injectable, Cabenuva
Transcript (English)
Dr. Brian Conway, MD, FRCPC
“Thank you very much to Sarah and Glenn. My name is Brian Conway, I'm the Medical Director of Vancouver Infectious Diseases Centre, and the newly founded Vancouver Urban Health Centre.
Unlike Sarah, I was there at the beginning, I have been involved in the field of HIV since I saw my first cases, perhaps people just like Glenn, at the Royal Victoria Hospital in Montreal, in 1984. I have followed the evolution of treatment options until the current era, when HIV right now can be easily controlled in the long term often with just taking one pill once a day. This gives people living with HIV infection the hope that although they can not be cured their infection can be controlled for the rest of their natural lives. However, for some, as you have already heard, this is not the best option, they worry about someone finding their pills. Over time, they may be forgetting to take their pills as regularly as they did in the past, and every time they take a pill they are reminded of the fact that they have HIV infection.
Some would prefer an alternative, much as women who take contraception, take a long-acting contraceptive as opposed to a daily pill. It’s a choice.
Over the past several years an injectable combination of antiviral medications, cabotegravir and rilpivirine, known as Cabenuva, has been evaluated in clinical trials and shown to be safe and effective in the setting of a switch from a pill to an injection, in the situation where the pills were highly effective.
A recent study has reinforced the benefits of Cabenuva, in comparison to a pill known as Biktarvy, which happens to be the most commonly prescribed HIV combination therapy in British Columbia.
This study was called SOLAR. It was presented for the first time at international conferences earlier this year. It included 670 participants, who were on and responding to it. They were randomized or assigned on a two to one basis, to receive either the injection every two months, the Cabenuva every two months, or to stay on Biktarvy. So, 447 people received Cabenuva, 223 received Biktarvy, and I should note that within the Solar study there were 52 Canadians.
After 12 months of either switching to Cabenuva or staying on Biktarvy there was no statistical difference. The two were undistinguishable statistically, 90% of people were still responding to Cabenuva, 93% of people were responding to Biktarvy. Now at the beginning of the study, almost half, 47% of participants, reported always or often experiencing one or more of the challenges in taking pills every day, such as being worried about people unintentionally discovering their HIV status. Being worried about forgetting to take their HIV medications. Feeling that taking their HIV medications was an uncomfortable reminder of their HIV status. Half of the people were saying that. So, after a year, 90% of people who were assigned to Cabenuva, they said: ok you were told in the study, you did a great job, now you can go back to the pills. They said: No, I’m staying on Cabenuva, I like this, I want to stay on Cabenuva.
So the top 5 reasons they said for wanting to stay on Cabenuva.
- I don't have to worry as much about remembering to take HIV medications every day.
- It's more convenient for me to receive injections every two months.
- do not have to carry my HIV medication with me.
- I do not have to think about my HIV status everyday.
- I do not have to worry about others seeing or finding my HIV pills.
Confirmed virological failure.
People were: well, they’re going to be on the shot it’s going to fail, and this is not a good thing. In all the people who were enrolled in the study, it happened in exactly 3 individuals. Now to be fair, these 3 individuals had viruses that were resistant to the Cabenuva, as consequence of the treatment failing, but it remained sensitive to other agents and it was very easy for these 3 individuals to go back on a pill that would work for them. It’s just an issue of monitoring.
So in other words, this risk of resistance, occurred in 0.67% of the people that were assigned to receive Cabenuva, and effective alternatives were available to them.
Now in terms of side effects, the main side effect was obviously related to the injection itself, the process of an injection. And 98% of these injection site reactions, as they are called, were considered mild, and they resolved within 3 days or less after the injection having been given. In 2% of cases, 2%, the injection site reactions led to the need to stop the Cabenuva therapy. And what do you do then, you just go back on the pills, Cabenuva is not for you.
Now as has been mentioned, Cabenuva has been approved by Canadian regulatory authorities for over 3 years, the exact date is March 18, 2020. It is approved as a complete regimen, that’s all you take for your HIV. For the treatment of HIV infection in patients who are 12 and over, who weigh 35 Kilograms or more, to replace an antiviral regimen that they are taking, that is actually working at that particular time. The injection can be given every 2 months, and to-date, 1,284, I found this out this morning,1,284 Canadians are benefiting from Cabenuva therapy across Canada. We're asking that it be made available
in British Columbia as it is in other jurisdictions.
Now the objections that have been raised are legitimate but at this point in time they’ve all been addressed. It is as effective as the most commonly used oral treatment for HIV as the SOLAR study has shown us when it is prescribed in the proper setting, as a switch strategy in those already responding to therapy. It’s safe. Only 2% of people felt the side effect that made it such that they had to stop Cabenuva.
The issue of resistance occurs in less than 1% of cases, and it can be addressed by switching back to a pill. And although this shouldn’t drive medical decisions people like it. Almost everyone on Cabenuva for a year wants to stay on Cabenuva even when they are offered the opportunity to go back to a pill. So, I represent a centre that has treated people with Cabenuva in clinical trials. It’s administration by injection. People have said that this is very complicated. It’s a bit more complicated than say administering the injections for syphilis, for the treatment of syphilis, that we do on most days.
The cost, in other parts of Canada is equal or less than the cost of pills, when you measure it over the entire year. And there are clear strategies that have been put in place to deal with the fact that someone may miss their injection, be late for their injection, or something else happens. There are strategies to deal with this. It is an issue but it can be addressed.
British Columbia is being asked to join the rest of Canada in this new era of injectable antiviral therapy. Let’s do the right thing for the men and women living with HIV in British Columbia.
The next time someone asks me if they can be on Cabenuva and they meet the scientific criteria for its use, please give me the privilege of saying it will be a pleasure to write the prescription for you.
Thank you.”
Dr. Brian Conway, MD, FRCPC
This News Conference was held at the Sheraton Wall Centre, in Pavillion Ballroom D, Vancouver, BC, Canada, July 12, 2023, on behalf of AIDS Vancouver.
"Reproduced with permission - Vancouver Infectious Disease Centre | VICD"
Vancouver Infectious Disease Centre | VICD
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