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Long-acting injectable treatment - what does this mean for people living with HIV?

18/11/2021

NICE decision on cabotegravir with rilpivirine (Long-Acting Injectables) – community guidance from UK-CAB (UK Community Advisory Board) and National AIDS Trust

NICE recommends first long-acting injectable treatment for people living with HIV

The National Institute for Health and Care Excellence (NICE) has approved cabotegravir with rilpivirine (CAB/RPV) as an option for treating adults with HIV in England and Wales. Provided the decision is not appealed, this means next year, people living with HIV in England and Wales will be able to access the first long-acting injectable used to treat HIV, an alternative option to taking daily pills.

People living with HIV must meet the following criteria before they can be considered for a switch to the CAB/RPV long-acting injectable:

  • An undetectable viral load (less than 50 copies/ml) whilst on an existing HIV treatment.
  • No history of resistance or virological failure to any non-nucleoside reverse transcriptase inhibitors (NNRTIs) or integrase inhibitors (INIs), due to the risk the drugs will not work effectively.

What happens now?

The new treatment is not available immediately. There are a number of steps before the new treatment will be available from HIV clinics:

  • Thursday 18 November 2021: Final Appraisal Document (draft guidance) published
  • Thursday 2 December 2021: Stakeholders appeals period closes. Grounds for appeal are strict, and are only considered if stakeholders believe NICE failed to act fairly or exceeded their powers, or the recommendation is unreasonable in the light of evidence submitted to NICE.
  • Wednesday 5 January 2022: The expected publication date of the recommendations (assuming no appeals are upheld). Legally new treatments must be available in Wales two months from this date, and three months in England.
  • Early March 2022: NHS Wales must start providing the treatment, unless an implementation extension is requested and granted.
  • Early April 2022: NHS England must start providing the treatment, we do not expect an implementation extension.

What about people living with HIV in Scotland and Northern Ireland?

Last month the Scottish Medicines Consortium (SMC) approved the use of the treatment for people living with HIV in Scotland. Decisions on treatment availability in Scotland are made at Health Board level. Waverley Care, THT Scotland and National AIDS Trust are writing to all the Boards to encourage consistent implementation and ensure that the treatment is available to anyone in Scotland who would benefit from it. 

It is our understanding that it is usual process for Northern Ireland to follow recommendations made in England and Wales.

Acknowledgements

NAT and UK-CAB would like to thank colleagues at Africa Advocacy Foundation, HIV i-Base, NAM aidsmap, Positively UK and Terrence Higgins Trust for their support and contributions throughout the technology appraisal process.


You can read the NICE guidance here

You can read our media statement on the news here.


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Nov 18, 2021 By joe.lester