Opinion: BC needs to provide access to long-acting HIV medications

Opinion: BC needs to step up and provide access to long-acting HIV medications

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Written for Daily Hive by Bradford McIntyre, an HIV patient advocate who operates www.PositivelyPositive.ca.

I have been living with HIV (Human Immunodeficiency Virus) for 38 years, and have had an undetectable viral load (less than 40 copies/mL) since 1998. Both of these facts are possible because of activism, community care, and HIV medications.

Bradford McIntyre/Submitted

BC has been my home for 28 years. I chose to live here because this province, and the BC Centre for Excellence in HIV/AIDS (BC-CfE), has led the charge in HIV treatment innovation throughout the epidemic: the development of HIV triple-drug combination therapy called “highly active antiretroviral therapy” (HAART), and for developing the Treatment as Prevention Strategy (TasP), which has linked patients to care, treatment and prevention. Working together with numerous community organizations, the BC Centre for Excellence in HIV/AIDS has saved the lives of thousands of HIV-positive people and reduced new HIV infections.

The tools that are available today have come a long way since the initial introduction of effective HIV treatment antiretroviral therapies (ART), in the 1990s.

The first reported cases of AIDS were 40 years ago, with no HIV treatment until 1987. The first treatment (AZT) was ingested every four hours. I knew I couldn’t possibly adhere to that regimen. In 1990, I started treatment twice daily, but I was unable to tolerate the drug and developed severe side effects.

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In 1998, I developed Pneumocystis pneumonia (PCP) and was unable to tolerate the medication for pneumonia. It looked as though I would die. My physician, an HIV specialist, recommended HIV triple-drug combination therapy. It was hoped that the drugs would decrease the amount of virus (viral load), making it possible for my own immune system to fight off the pneumonia. The treatment was successful!

In 1998, HIV genotyping, resistance testing, showed I would likely develop resistance to the current HIV medications available. In 2000, I enrolled in a one-year drug study trial for a Protease Inhibitor. The study drug was approved in 2001 for public use by the Canadian Food and Drug Administration. I continued taking this drug until 2015, but concern for my kidneys lead me to another study. In 2015, I enrolled in a five-year open-label study to evaluate switching from my current triple-drug combination regimen to a once-daily single-tablet regimen. In April 2018, Health Canada approved the study drug for the treatment of HIV infection.

HIV treatments save lives, and advancements in treatments made it possible for me to live. Without newer HIV treatments, I would not be here. Today, I’m on a one-pill-a-day regimen and I have a CD4 count of 1140, on par with people who are HIV-negative. I have been undetectable since 1999. I don’t take my health today for granted. It’s only possible because of adherence – taking pills every day, as prescribed, for the rest of my life. Let me say that adherence is not easy.

Adherence is necessary to succeed in viral suppression. Undetectable = Untransmittable. Taking pills every day can affect adherence. Not adhering to HIV meds can cause viral rebound, and drug resistance that allows HIV to reproduce, while on the treatment of antiretroviral (ARV) drugs. Pill fatigue, health, changes in routine, living conditions, isolation, poverty, depression, substance abuse, and lack of support, are some of the factors that may affect adherence.

Aging is a factor in adhering to HIV treatment

In both Canada and the United States, over 50% of people living with HIV are over the age of 50. There are many people like myself, who are long-term HIV survivors and now struggling with aging issues. Older adults and long-term survivors may have multiple chronic conditions that require taking many medications, contributing to difficulty adhering to HIV treatment. Personally, I am dealing with neuropathology, a deterioration of the nerves in my legs, caused by AZT, along with thyroid disease caused by both HIV and the medications to treat HIV and hypertension. All of these require medications.

The largest challenge we face, in controlling HIV infection and eliminating new HIV infections, is the ability of people living with HIV to manage their daily treatment regimen.

Keep in mind, HIV medications are lifesaving when taken daily. In the absence of HIV treatment, the life span — and the quality of life — for those of us living with HIV is dramatically lessened.

There is a solution. In 2020, Health Canada approved Cabenuva, the first long-acting HIV treatment by injection instead of daily pills. HIV-positive people, who meet the criteria can opt to receive injections every month or every two months, from their healthcare professionals.

Unfortunately, this long-acting treatment is not currently covered in our home province. Despite our world-leading efforts in fighting HIV/AIDS, we have fallen behind in making the latest HIV drugs available to people in British Columbia, who need them.

An estimated 7,560 British Columbians are living with HIV.

Today, if you live in provinces like Alberta or Ontario, you can access Cabenuva.

Unfortunately, it is still not a reality in British Columbia. This lack of access is true whether your healthcare is funded by the province or the First Nations Health Authority. Although elsewhere, Status First Nations people have access to Cabenuva.

Advocates from HIV/AIDS service organizations throughout the province, like AIDS Vancouver, can tell you that there is a clear need for long-acting antiretrovirals like Cabenuva. They are aware of people, who have been following the development of long-acting HIV treatment options, waiting for the day it will be available to them. I look forward to the day when I no longer need HIV meds in pill form!

Long-acting injectable HIV treatments are not for everyone. There are HIV-positive people, who will continue to take their daily pills successfully. For some, this new option will make a real difference in their lives. Long-acting HIV therapies are a real game changer to ensure that people living with HIV in British Columbia have access to medications that are right for them.

By following our past successes of innovation and leadership in the introduction of truly life-changing methods of treatment, it makes sense that we continue by ensuring that HIV treatments like Cabenuva are covered and listed by British Columbia’s provincial formulary.

If innovation in the treatment of HIV stops today, we create an inequality inside Canada with the availability of HIV treatment options available for some but not others. We must ensure that we do not leave anyone behind in British Columbia.

Nearly four decades after my HIV diagnosis, I’m confident that through innovation, the future is bright for people living with HIV. Right now, we have some catching up to do.