UK Community Advisory Board (UK-CAB)

Long-acting Injectables: when will they be available?

As awareness of long-acting injectables grows, more people living with HIV are asking when this new type of medication might be available in the UK.

How does long-acting injectable HIV treatment work?

There are several long-acting injectable treatments in development, but only one combination so far has successfully gone through the research and trials needed to gain approval for use in North America and Europe.

A combination of two drugs, rilpivirine and cabotegravir make up the new injectable most people are talking about:

  • Rilpivirine, an existing HIV drug in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class of drugs. The brand name being used for this treatment (in injectable form only) is Rekambys.
  • Cabotegravir, a new HIV drug in the integrase inhibitor (INI) class of drugs. The brand name being used for this treatment is Vocabria.
  • The brand name Cabenuva is being used in some countries to describe both drugs packaged together.

As the treatment is made up from two different drugs, two separate injections are given. Usually, one injection is given in each buttock (butt cheek). This must be done by a nurse or healthcare professional. In the first trials injections were delivered once a month, but further research showed that the drugs could be given every two months.

Before beginning the injections, you must take the two drugs in tablet/pill form for 30 days. This is to check that there are no major side effects for either of the drugs and also to ensure that these drugs keep your HIV under control.

Are there side effects?

As with any treatment some people can experience side effects. During the trials the most common were injection site reactions (bumps or pain in the place where the injection was given); headaches; and raised temperature.

Is injectable treatment suitable for everyone?

Before starting injectable treatment, you must have a sustained undetectable viral load. This means that injectables are not suitable for newly diagnosed people.

When will I be able to get this treatment from my clinic?

Injectable treatment is not yet available on the NHS anywhere in the UK.

The Scottish Medicines Consortium (SMC) is reviewing the treatment this summer. Patient groups, such as HIV charities in Scotland, have until 2 August 2021 to send their views about the treatment to the SMC. For example, we understand that Waverley Care and HIV Scotland plan to contact SMC in support of the new treatment.

If you live in Scotland, you might want to contact your own local HIV support service to find out whether they intend to respond.

We are still waiting to find out when injectable HIV treatment might be made available in Wales and Northern Ireland.

In England the process is different and slightly more complex. Previously HIV treatments were subject to the specialised commissioning process.  However, in 2020 it was announced that HIV drugs would follow the National Institute for Health and Care Excellence (NICE) technology appraisal route, which is how the majority of new drugs for other conditions are approved.

In August, a committee will meet to provide evidence and discuss the treatment.  Experts from the community will be there to give the views of people living with HIV, including UK-CAB Chair, Alex Sparrowhawk. NICE will then decide if NHS England should make injectable treatment available. If they decide that it will be made available to people living with HIV then it must be available no more than three months after that decision is announced. As the decision is expected at the end of October 2021, the earliest people living with HIV could get injectable treatment would be at the end of 2021, or early 2022.

Want to know more?

UK-CAB members have been following the development of this treatment for some time through the clinical trials: FLAIR, ATLAS and an on-going trial called ATLAS-2M. The latest information on these trials was shared at the UK-CAB meeting in February this year [PDF].