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Beyond HIV: Applying Long-Acting Formulations to other Infectious Diseases

This post is part of an ongoing series on HIV/AIDS in recognition of HIV/AIDS awareness month 2022. In this series, we focus our posts on education, research, achievements, and medicine pertaining to the HIV/AIDS epidemic.

In our previous post, we reviewed the merits of long-acting HIV treatments as a recent breakthrough in HIV/AIDS medical research. Briefly, these treatments may replace daily oral medication(s), instead offering injectable treatment that lasts for months between doses. This has the promise to ease the burdens of daily pills as well as help contribute to increased compliance, decreased HIV burden in the community, and potentially slow the development of antimicrobial resistance to these crucial drugs.

These same benefits touted for long-acting HIV treatment formulations theoretically can be applied to a host of other infectious diseases which require either short- or long-term antibiotic/antiviral regimens. This is a topic explored in many articles included in the Long-Acting and Extended-Release Formulations for the Treatment and Prevention of Infectious Diseases supplement in the journal Clinical Infectious Diseases. Today, we feature a few of theses articles as we explore how advances in HIV medicine may spill over and benefit all of Infectious Disease.

Tuberculosis is caused by the pathogen Mycobacterium tuberculosis and most commonly involves infection of the lung, among other tissues. Unlike most infections, tuberculosis can manifest acutely with primary tuberculosis as well as go dormant and asymptomatic for a period of years in a manifestation called latent tuberculosis. This latent type of infection can then reactivate, causing secondary tuberculosis. Despite this, it is considered a very treatable disease, but is complicated by high prevalence in developing nations where access to medical care may be suboptimal, a long course of antibiotic treatment needed (sometimes upwards of 6-9 months) for effective clearance, and a significant side effect profile of medications used. These factors make tuberculosis treatments ideal candidates for long-acting formulation. Indeed, this is the idea that is explored in this article, co-authored by Dr. Susan Swindells. Check out the full manuscript for an overview of the specific considerations and current preclinical advancements relevant for the development of long-acting technologies of TB drugs for treatment of latent infection, including attributes of target product profiles, suitability of drugs for long-acting formulations, ongoing research efforts, and translation to clinical studies. With more research, this technology could be leveraged to generate a one-shot-cure for latent TB.

Hepatitis B and Hepatitis C are two additional infectious diseases where treatment may be substantially improved with long-acting formulation technology. The considerations of this are explored in two articles included in the supplement (Long-Acting Treatments for Hepatitis B and Prospects for Long-Acting Treatments for Hepatitis C). In the case of HBV, weekly injections of pegylated interferon alpha are already currently in use as a semi-long acting formulation. Even longer acting formulations may, with additional research, further effectively combat this virus and help prevent mother-to-infant transmission, which is the predominant route of transmission worldwide. This is crucially important as there is no current cure for hepatitis B infection, making long-term pharmaceutical treatment our only tool to prevent transmission. HCV, on the other hand, can now be cured in most people with 2-3 months of treatment. Much like in the case of tuberculosis, this requires adherence to consistent dosing of an oral medication. It follows then that the same benefits that long-acting formulations may provide to tuberculosis also extend to HCV infection, with the hope of a one-shot-cure that would benefit those living with HCV in areas without robust access to pharmacies or medical care. Read both articles (here and here) for the full details on the progress and work still needed before these treatments can be utilized to improve care for people living with hepatitis B or C.

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