HIV advocates frustrated over access to monthly treatment, but researcher cautions over eligibility

Nearly three years after injectable HIV treatments were approved by Health Canada, a B.C. advocacy group is calling for expanded access to the treatment for people in the province. 

But researchers say not everyone living with HIV is eligible for the injection, given the risk of developing drug resistancy to other HIV treatments. 

While there is no cure for HIV, a sexually transmitted infection that breaks down the body's ability to fight infection and disease, medication is used to control the progression of the virus. 

Cabenuva, the injectable treatment, is the only long-lasting drug option for HIV patients in Canada aside from a daily pill option. 

The drug is administered monthly with the help of a patient's health-care provider. 

AIDS Vancouver is calling on the province and the B.C. Centre for Excellence in HIV/AIDS (BC-CfE) to expand the treatment's availability to all people living with HIV, but according to the research foundation, being eligible for the treatment comes with complex considerations.

"We decided that we needed to start with caution because the drug is extremely fragile. It's unlike anything else that we used before," said Julio Montaner, executive director of the BC-CfE.

He adds only a small group of people can safely and effectively take the medication. 

Limited eligibility

Sarah Chown, executive director of AIDS Vancouver, says the advocacy group approached the BC-CfE regarding the treatment in the fall of 2022, and that the centre claimed the drug was difficult to distribute due to health-care administration issues, such as cold chain management to keep the drug cool. 

"We're the only province where it's not available. All the other provinces have mechanisms for people to access this [treatment].

"[Issues have] been figured out in every other province, so the issues aren't unique to British Columbia," she said.

Montaner says drugs cannot be made widely accessible purely based on their approval. 

He says drugs in B.C. are approved in different tiers, from preferred treatments that are cost- and medically effective, to treatments used only in special circumstances due to high prices and concerns with safety and efficacy.

"The complexities of implementing the program are significant," he said, adding around three to five people in B.C. currently have authorization to use Cabenuva. 

Montaner says applicants need to meet specific criteria regarding their lifestyle, age, weight, history of drug resistance, and track record of treatment usage. 

People outside of the eligibility window are at high risk of developing drug resistancy, he says, which can make other HIV treatments ineffective. 

"Around 75 per cent of the requests we received [for Cabenuva] were deemed to be medically not advisable," he said.

The provincial Ministry of Health says eligible patients can apply for Cabenuva through their health-care providers, which is reviewed by BC-CfE on a case-by-case basis.

"The eligibility criteria for Cabenuva in B.C. will be adjusted as necessary as the evidence evolves," said a ministry spokesperson.

"Because of the particulars of the drug, this is recommended in very specific clinical circumstances, consistent with the product's regulatory approval."

'Stigma and discrimination continues'

Chown says patients are often asked about their health when they are seen taking or carrying pills daily.

With an injection, she says, those questions can be avoided, and people with HIV can maintain their health privacy. 

"Stigma and discrimination continues, and in a lot of cases, people living with HIV face violence when they disclose an HIV status," she said.

For several years, Chown has heard from community members and HIV patients about the frustration of not having access to Cabenuva. 

"[B.C. patients] tell me their friends with HIV in other provinces have access to this treatment, but are confused why they don't," she said. 

Montaner says it's not true that Cabenuva is more accessible in other provinces. 

He feels people inaccurately believe the drug is widely used, due to participation in clinical trials that took place in other provinces before Cabenuva's approval in 2020. 

Montaner says colleagues in "a province close to ours" have said their post-approval Cabenuva program enrolled 14 patients, with only one person still actively using the medication. 

"When people made these statements that the drug is widely used, there's a lot of wishful thinking in those statements," he said.

"British Columbia has achieved the best control of HIV in the country because we have the most generous HIV treatment program in the whole of the country."

According to data from the BC-CfE, nearly 16,000 people have received treatment for HIV in B.C. since 1992.

In a statement, Health Canada says "it has no jurisdiction over how health-care professionals prescribe drugs once they are approved."

They add provincial and territorial health authorities rely on medical journals, reports, and peer-reviewed studies to determine the prescription, coverage and availability of approved drugs in their region.