The next new shot: Help for patients diagnosed with HIV

For years, people diagnosed with HIV have taken a steady regiment of oral medication. Now, there’s something new on the market and IU Health recently administered the first dose.

By IU Health Senior Journalist T.J. Banes, tfender1@iuhealth.org

For 25 years Ambulatory Nurse Clinician Beverly Albert worked at Riley Hospital for Children at IU Health where she cared for some of the youngest diagnosed with an infectious disease. Many of those 6- to12-year-olds were diagnosed with HIV.

“It was 1988 when the Aids epidemic was in full force. I saw how pediatric patients were diagnosed in utero, through blood transfusions and hemophilia,” said Albert who has been a nurse for 35 years. Ryan White was one of those Riley patients. As a teenager in 1984 he was diagnosed with AIDS following a blood transfusion. He died April 8, 1990, at the age of 18.

In the past two years Albert has worked with LifeCare at IU Health – one of the state’s largest providers of HIV treatment and medical prevention.

“It’s been exciting to see the new medications in HIV care that have come about over the years and how people live with HIV and they’re not passing away from it,” said Albert.

On the last Tuesday in March, Albert was another part of the history of HIV treatment and prevention. She administered the first FDA-approved, long-acting injectable HIV treatment for adults, consisting of two shots administered monthly.

CABENUVA – manufactured by ViiV - is a milky white liquid administered at separate gluteal injection sites.

The first patient to receive the medication was a female in her 60s. She did not wish to be identified for fear of discrimination.

“While we’re focused on treating the diagnosis, the pervasiveness of the stigma of those with HIV is still very prevalent even in 2021,” said Kyle Bonham, manager of clinical operations for LifeCare. Located in IU Health Methodist Hospital, LifeCare staff includes nurses, infectious disease physicians, licensed social workers, clinical pharmacists, psychiatrists and other support staff. Together they offer confidential HIV testing, health assessments and physical exams, comprehensive treatment plans, lab work, immunizations and vaccinations and access to specialty and community referrals.

The first CABENUVA patient was diagnosed with HIV about 17 years ago. She said a male partner infected her and she didn’t know he had been diagnosed with HIV. Until the shot became available she, like many of those infected with HIV, was taking daily oral medication – an antiretroviral therapy (ART). The side effects of the traditional oral medication can include abdominal pain, pancreatitis, skin rash, increase in cholesterol, and fat loss in arms, legs, or face.

“I chose the shot because I always worry that there might come a time I would forget to take the pills,” she said. “This is more convenient. This is something I will always live with and in some ways I will always feel like my life is lived in a little square – always being cautious that I don’t pass it on,” said the LifeCare patient.

Pharmacy Technician Elizabeth Schey assists LifeCare patients with enrollment and information on covering the cost of the shot if their insurance does not. She has also worked with the drug manufacturer for pre authorizations and arranging the drug shipment and deliveries.

“The most challenging part of all of this is it’s brand new so it’s like building the bridge as we’re crossing it,” said Schey, who has worked at IU Health since October 2019. “It’s been a step by step process. There’s never been anything on the market before so we’re learning as we go and we’re also learning how to help patients get access to the shot.”

It’s been a team effort.

The shot requires a month lead-in phase with oral medication to make sure the patient tolerates the medication, said LifeCare Clinical Pharmacist Emily Huesgen. Eligible patients must have a viral suppressed load on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to the medication.

Patients are counseled about the importance of adherence to scheduling monthly visits to help maintain viral suppression and reduce the risk of viral rebound and potential development of resistance with missed doses.

They are also monitored after the drug is administered – checking for any possible side effects, which could include fatigue, and soreness in the area of injection.

Some patients may not choose the shot because they are afraid of needles, said Huesgen, who has worked with HIV patients for a decade. Other patients may face challenges with childcare, and transportation, or simply be too busy to make monthly appointments.

Huesgen estimates between 13 to 20 percent of their patients will opt for the shot.

She said: “As the evolution of HIV care goes, I see this as a means of freedom from the daily reminder of medication and the weight that carries if there are side effects.”