NICE backs ViiV/J&J's six-per-year injection for HIV

People living with HIV in England and Wales now have an alternative to daily oral tablets, after NICE backed NHS use of two long-acting injectable therapies developed by ViiV Healthcare and Johnson & Johnson's Janssen pharma unit.

The cost-effectiveness watchdog has recommended the use of ViiV's Vocabria (cabotegravir) with Janssen's Rekambys (rilpivirine) as a combination therapy for adults with HIV whose viral load levels are controlled on their current antiretroviral therapy (ART).

The regimen, which consists of six treatment days per year after an initial lead-in period with oral dosing and initiation injections, was approved last December by the European Commission.

ViiV – which is majority owned by GlaxoSmithKline with Pfizer and Shionogi as shareholders – said that this is the first time that an HIV treatment has ever been appraised and approved by NICE.

The regimen has already been approved for use by NHS Scotland by NICE's north of the border equivalent, the Scottish Medicines Consortium (SMC).

Reducing the number of injections would be welcomed by patients who rely on cocktails of drugs to suppress HIV. Around 13,000 people in England are expected to be eligible for the new treatment.

Daily ART has transformed the lives of people living with the infection, but can pose challenges for some people who struggle to comply with treatment. Meanwhile, it can act as a constant reminder of HIV or be a cause of fear that their HIV status will be disclosed.

The long-acting regimen of cabotegravir and rilpivirine was as effective as treatment with current daily antiviral therapy in the clinical trials, and in follow-up studies a two-monthly regimen was found to be equivalent to a once-monthly dose in maintaining viral suppression.

"We still have a long way to go in educating around HIV, but today's announcement demonstrates how far we've come since the 1980s epidemic," said Garry Brough of patient organisation Positively UK.

"It is a huge step forward in offering people living with HIV in England and Wales greater choice in how they manage their condition," he added, noting that having to take tablets every day can be physically, emotionally and socially burdensome for some people.

A poll of people living with HIV found that 60% live in fear that their HIV status will be shared without their consent, with 45% saying their status was revealed because someone spotted the medicine they were taking.

"This decision reflects the rightful need for people living with HIV to have the freedom to manage their HIV in a way that works best for them, helping them to live their life to the full," said Brough.