How Do Injectable HIV Drugs Work?

This year, Canada became the first nation in the world to approve a monthly injectable all-in-one HIV treatment, ViiV Healthcare’s Cabenuva (a combination of the drugs cabotegravir and rilpivirine). While approval in the U.S. hit a bump over scale-up readiness, other injectable HIV treatment are on their way. Trogarzo, an injectable for people with treatment resistant  HIV, must be combined with other meds and taken every two weeks. Other long-acting, all-in-one injectables like Cabenuva are also in the pipeline. Meanwhile, GlaxoSmithKline is finding success in an injectable HIV prevention treatment that is still in clinical trials. But, exactly how does it all work? Nicole Thibeau, PharmD, director of pharmacy services at the Los Angeles LGBT Center, answers our burning questions.

With injection meds, do folks usually inject themselves or does their doctor do it?
It depends on the specific medication and the patient’s comfort level. Some injectable medications need to be administered by a medical provider, especially long-acting medications, which are given once a month or less frequently. They must be injected in a specific area and specific way to make sure they release properly. If done incorrectly, it could harm the patient. Medications, such as hormones and insulin, that are injected more frequently, daily or weekly, are more likely to be injected by the patient. I imagine many of the injectable HIV prevention and treatment medications will require administration by a medical professional. (Editor’s note: In Canada, the HIV drug Cabenuva is being delivered via once monthly injections in doctor’s offices.)

Do people have the option of going to a doctor's office to have it done?
Yes. Regardless of the medication, some patients don’t feel comfortable injecting themselves. So, even if medications can be self-administered, they may come to the provider’s office to have it administered by nursing staff. These visits are likely to be billed to the patient’s insurance, which may be a factor in their decision to self-inject or not.

If you self-inject, do you need to buy needles or are they provided at a pharmacy?
Some medications may include the supplies needed to self-inject, but most require separate needles and syringes. Depending on state law, a patient may be able to purchase these at the pharmacy without a prescription, or the pharmacy may be able to bill them to insurance if the medical provider writes the supplies as a prescription. It generally depends on the patient’s prescription coverage.

Do they cost anything?
If they’re not included with the medication from the manufacturer or not covered by insurance, there is a cost, which varies due to size, quantity, and any special safety features of the needles and syringes.

Is there anything people should have handy when they self-administer?
Patients should have alcohol prep pads to clean the area before injection and a sharps container to dispose the needle safely. They should also be aware of where to return the sharps container when it’s full.* Also, a patient should undergo injection lessons for their specific medication from a doctor, nurse, or pharmacist prior to self-injecting. Different medications require different locations and techniques.

*Editor’s note: Sharps containers are usually available at pharmacies, hospitals, retailers like Target and Walmart, and even online. If you can’t afford to purchase one and your FSA or insurance won’t cover it, a heavy duty laundry detergent container with puncture proof lid is also acceptable. Label it hazardous waste and check SafeNeedleDisposal.org for where or how to dispose of it when full.