Positively Aware Editor Jeff Berry
Jeff Berry @paeditor

While those ADAP waiting lists are gone, they’ve been replaced by the continued assaults by this administration on vulnerable populations and on the Affordable Care Act (Obamacare), the rising prices of pharmaceutical drugs, and soaring healthcare costs including premiums, cost-sharing, and deductibles, that are unsustainable.

In this day and age it’s easy to find reason to despair. But when it comes to HIV treatment and drug development, there are many things that continue to give us hope.

This is the 24th annual Positively Aware HIV Drug Guide, which provides invaluable information on HIV treatment and care. The HIV Drug Guide is used as a resource throughout the year by people living with HIV (PLHIV) and their providers, and is our most requested issue every year. As I sat down to write this note, I went back to the 2007 Drug Guide to see what’s changed—and what has remained the same.

Back then I wrote:

2007—not only did many of us think we would never live to see it, but the fact that there are now nearly 30 drugs for us to choose from to construct an anti-HIV regimen is almost unfathomable. Yet here we are.

We have much to be thankful for. Many new therapies are in the pipeline, and at least three are nearing approval. One is already in expanded access, another is due to open in the next few months, and both of these are in entirely new classes of drugs. It’s being said that we will probably never again be in such good shape as far as new drugs and opportunities
to combine them, at least not in the near future.

Yet here it is 13 years later, and we are in good shape once more! Today we list 39 HIV drugs in the guide, and if you add in all the drugs currently on the market including those that are seldom or rarely used, there are actually 50 drugs. Some of the more recently approved drugs (such as Cimduo or Temixys) are what in the past we would have called “me too” drugs, although that phrase has taken on a whole new meaning in the last few years. With the continued introduction of generics and “quasi-generics” (co-formulations with one or more generic drugs as a component) these “look-alike” drugs serve a purpose by potentially keeping the price of the drug lower, and copays fewer.

This year, as in 2007, we have exciting new drugs in the pipeline (see page 63), including for people who are heavily treatment-experienced and have multi-drug resistance, such as fostemsavir, and leronlimab. As people live longer with HIV but have run out of options, it’s good to see medications being developed for this population. The investigational cabotegravir/rilprivirine LA will soon offer a completely new choice for HIV therapy, a monthly injection that is a complete regimen all in one.

Weight gain is an increasing concern for those on antiretroviral therapy (ART), so Dr. David Wohl (see page 8) looks at the evidence we have to date, what steps you can take now, and things you may want to consider for the future.

We had people dying in 2007 while being placed on waiting lists for state AIDS Drug Assistance Programs (ADAPs). While those waiting lists are gone, they’ve been replaced by the continued assaults by this administration on vulnerable populations and on the Affordable Care Act (Obamacare), the rising prices of pharmaceutical drugs, and soaring healthcare costs including premiums, cost-sharing, and deductibles, that are unsustainable. In January, the administration issued guidance that allows states to request capped block grant funding for their Medicaid programs. Medicaid accounts for 30% of all federal spending on HIV care (second only to Medicare), and provides coverage to 42% of PLHIV, says NASTAD’s Dori Molozanov in a recent blog. “A block grant would lead to cuts in access to services with negative consequences for vulnerable populations, including people living with or at risk for HIV and hepatitis, who depend on Medicaid coverage in order to receive the care they need.”

On the plus side, what we didn’t know then but do now is that PLHIV on treatment who have an undetectable viral load cannot sexually transmit the virus (U=U, or undetectable equals untransmittable). But making sure people have universal access to HIV medication (the third U) is crucial, and we also need to ensure that we continue to support and aren’t stigmatizing those who for whatever reason cannot achieve or maintain an undetectable viral load.

This drug guide would not be possible without a team of experts who make all the magic happen. A heartfelt thanks to Dr. Ross Slotten (my fabulous personal physician), Bridgette Picou, Dr. Eric Farmer, Dr. Carla Blieden, Dr. David Wohl, Enid Vázquez, Rick Guasco, Jason Lancaster, Andrew Reynolds, John Gress, and Wyll Knight.

Let’s keep looking for reasons to hope, because they are still here. It may just be that we have to dig a little bit deeper to find them.

Take care of yourself, and each other.