Treatment for HIV has evolved over the decades as new antiretroviral therapies (ARTs) continue to help people living with the disease avoid comorbidities and keep the virus undetectable. Michelle Agnoli, RN, MSN, provided her advice on a range of topics including anti-HIV medications, vaccinations, screenings, and how to find a healthcare provider.
A nurse for 30 years, Agnoli began her nursing career in the lab but transitioned to caring for and training others to care for people with HIV at the UI Health Community Clinic Network (UCCN) in Chicago. As a Ryan White HIV/AIDS Program, UCCN can provide services to individuals regardless of their insurance coverage.
Injectable treatment eliminates the daily pill struggle
One of the newest treatments is an injectable HIV therapy called Cabenuva, a drug containing cabotegravir and rilpivirine. The regimen begins with a monthly shot in each buttock for the first two months, and then continues with an injection in each buttock every two months.
“This drug is fantastic for anyone who struggles with daily pills or has a low-grade viral load,” Agnoli said. “It’s been freeing for many people because they meet with their healthcare provider once every two months for the injection instead of having a daily pill regimen.”
Sometimes, providers will prescribe cabotegravir and rilpivirine oral medications for a month to make sure the patient can tolerate them before starting the Cabenuva injections, Agnoli said. “This is a provider preference and something to discuss with your provider,” she added.
Side effects of the injectable treatment may include headache, tiredness, dizziness, pain, swelling or lump at the injection site, rash, liver problems, mood changes, or allergic reactions. Patients allergic to cabotegravir or rilpivirine should not take Cabenuva. “If you experience any severe allergic reactions, call 911. Contact your health care provider if you are experiencing any unusual symptoms,” Agnoli advised.
Most patients tolerate Cabenuva very well. “I’ve seen it do wonders for people who have struggled to maintain an undetectable viral load. It allows patients freedom from pill taking,” Agnoli stated.
If you are over 7 days late with your Cabenuva injection, contact your provider. You may need to go back on oral medications and reinitiate the injections.
Again, you should not take Cabenuva if you are allergic to cabotegravir or rilpivirine.
New daily pill medications offer options
Patients living with HIV also have more options if they prefer to take a daily pill to keep the virus undetectable.
“Many of the pills are much more tolerable than before, with fewer side effects,” Agnoli stated. New medications include Triumeq, Biktarvy and Dovato. “People living with HIV have options and can try another medication if they don’t like how a certain medication makes them feel,” she added.
Updated PrEP includes injectables
HIV-preventive drugs now include injectable anti-retroviral therapy, or ART. Apretude (cabotegravir) can be used for injectable PrEP. Like Cabenuva, Apretude is given one month apart for two months, then every two months.
Lenacapavir is being investigated as an injectable PrEP formulation to be injected every six months. It is currently approved as Sunlenca for use in patients who have limited medication options due to resistance.
In addition to taking PrEP to prevent HIV, a new protocol can help prevent sexually transmitted infections (STIs). “If you’re somebody who is sexually active and has unprotected sex, you can take an antibiotic to prevent the acquisition of gonorrhea, syphilis and chlamydia in addition to taking medication to prevent HIV,” Agnoli said.
Those who fear they may have contracted HIV because of a sexual encounter can take doxy-PEP, which stands for doxycycline post-exposure prophylaxis. A 200 mg pill of doxy-PEP must be taken as soon as possible but no later than three days after having sex without a condom.
Results of a 2023 study in the New England Journal of Medicine found that transgender women and men who have sex with men who took doxy-PEP within 72 hours of condomless sex reduced incidences of bacterial STIs – specifically gonorrhea, chlamydia, and syphilis – by two-thirds compared to those receiving standard care without doxy-PEP.
Vaccines reduce risks of co-morbidities
Persons living with HIV can benefit from staying current on vaccines that reduce the risk of potential co-morbidities including:
- Human papillomavirus
- Hepatitis A and B
- Respiratory syncytial virus (RSV)
Work with your healthcare provider to keep a schedule for the vaccines that are best for your personal health.
Regular screenings an important aspect of medical care
Regular screenings are an important part of all medical care, with mammograms, pap smears, blood tests, colonoscopies, and prostate-specific antigen (PSA) tests conducted according to age, sex, and personal and family medical history. Persons living with HIV should be screened for tuberculosis, hepatitis C, and STIs annually. “Patients who have been more active sexually should be screened for STIs more frequently,” Agnoli stated.
Patients can find care from a qualified provider
Finding a qualified healthcare provider may challenge some persons living with HIV, especially if they aren’t ready to disclose their health status. Others living with HIV might be uncomfortable in their current medical care situation and have decided to find another provider.
“If you are in a community with folks you know, positive, word-of-mouth recommendations for a competent practitioner can be effective,” Agnoli advised. Physicians, nurse practitioners, physician assistants, and pharmacists who specialize in advanced care for people living with HIV may earn professional certifications that demonstrate their expertise in working with HIV patients.
These online resources can also help locate a healthcare provider qualified to treat HIV:
Illinois: Illinois HIV Care Connect offers confidential, online enrollment for HIV services provided to qualified individuals living within all of the state’s 102 counties.
Chicago area: The AIDS Foundation of Chicago and Center on Halsted offer a resource HUB listing healthcare services for the LGBTQ+ population and those living with or vulnerable to HIV.
Throughout the country: The Ryan White HIV/AIDS Program Medical Provider Tool from the Health Resources and Services Administration locates HIV care and support services by ZIP code. Individuals also can call their state HIV/AIDS toll-free phone number for more information. In Illinois, call 800-243-2437 or TTY/TDD: 800-782-0423.