Lionel Hillard’s boss asked him to come into his office. It was the late 1980s in Dallas. The then 29-year-old was a medical assistant at a busy clinic with a room full of patients. But the doctor who ran it said he needed to talk with him about the results of his routine blood work.
Hillard held it together for the rest of the workday, then broke down when he got home. He had been working with people with HIV for years, in an era when that diagnosis often meant a rapid march to death. “I was working with people who were HIV positive and was teaching their families how to let them go,” Hillard says. Now, he had to counsel himself.
Somehow, Hillard survived. And in the nearly 30 years since his diagnosis, he has seen HIV go from certain killer to treatable to one-pill-a-day preventable. It’s remarkable, he says, but it’s not enough.
Thanks to a suite of antiretrovirals that people take daily, HIV has turned from a sure killer to a chronic disease in much of the developed world. But as life spans go from months to decades, convenience has become an important factor in getting people to take their medication. Pharma has responded, creating a new wave of injectable HIV treatments that can be given once every few weeks. People living with HIV say the lower frequency takes away the daily reminder of the disease. But in some places in the US, it’s not clear if injectables will ever catch on.
Hillard, now 58, is an advocate for people living with HIV, engaged and active in understanding the newest treatments. He has participated in clinical trials, including one for Trogarzo, an injectable HIV drug for people whose viruses have become resistant to older therapies. He takes it regularly, heading to his doctor for an injection every 2 weeks. Theratechnologies’ Trogarzo is one of a growing number of injectable HIV drugs, both approved and in development, that promise efficacy, as well as discretion for those scared to live openly with their HIV status. An injection, some say, resolves the constant reminder of HIV status that taking a daily pill brings.
The rise of injectables is emblematic of a gradual culture change for people with access to good HIV care. Although still a serious illness, HIV has effectively become a chronic disease in the US, manageable by adherence to medication. While scientists work on a practical cure for HIV that can treat the largest number of people, some pharma companies are still chasing new HIV drug targets and trying to make treatment more meaningful and long acting. Drugmakers tell C&EN that for the injectables in their pipelines, the idea is convenience over a lifetime of use.
Convenience. After decades of pills, including the canonical triple therapy, Hillard likes how that sounds.
“It gives you the freedom that you don’t have to think about it—oh, did I remember to take my pill today?” he says. “I believe there will be a drawn attraction to the injectable and not having to carry these pills around.”
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