Considerations for long-acting antiretroviral therapy in older persons with HIV

Abstract

People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.

Cardiac and Renal Comorbidities in Aging People Living With HIV

“…37 Furthermore, as PLWH age, increasing drug burden, polypharmacy, and metabolic changes, especially in the presence of renal or cardiac disease, may predispose patients to adverse drug toxicities. 186…”

Aging on antiretrovirals: reviewing the need for pharmacologic data in elderly people with HIV

“…Recent pharmacokinetic modeling suggests that age-related physiologic changes are predicted to modestly increase exposures of long-acting cabotegravir and rilpivirine when administered every eight weeks; this implies that the elderly may be at lower risk of experiencing suboptimal drug concentrations at the end of each dosing period [ 49 ]. On the other hand, decreased muscle volume could potentially predispose the elderly to improper injection technique and possibly greater risk of injection site pain or reactions [ 50 ]. Finally, certain age-related comorbidities may contribute to poorer perfusion of subcutaneous (SC) tissues, in turn leading to decreased absorption of SC injections [ 51 ].…”