No matter the advances made in medicine, a pill will only be effective if you actually take it as directed — something that many patients struggle with. But what if you could take a week’s worth of medicine in one dose?
Boston-area researchers have found to make that a reality for those treating and preventing HIV.
In a study published Tuesday, researchers at the Massachusetts Institute of Technology and Brigham and Women’s Hospital detail their development of an oral, once-weekly “drug delivery system” for HIV that delivers a weekly dose of antiretroviral therapy — the drugs that prevent the growth of the virus — in one go.
It’s basically a “pillbox in a capsule,” as Giovanni Traverso, a senior study author, called it — and it may revolutionize HIV care.
Here’s how it works: Researchers developed the capsule as a star shape that has six “arms,” each of which can be loaded with a different drug. Those arms fold in and the entire capsule is encased in a coating so that it can be swallowed.
Now, researchers have made adjustments to the materials of the capsule so that it can hold different types of drugs and release them at different intervals throughout a week. The capsule eventually disintegrates and leaves the body through the digestive tract.
Why researchers focused on treating HIV
“Up until a few years ago, most of the HIV medications needed to be taken multiple times a day, and at that time people came out with single tablet regimen — patients now needed to take the medicine just once a day — and it was considered to be a huge advancement,” said Ameya Kirtane, an MIT postdoc and one of the lead authors of the paper.
“[But] even with just once-daily medications, patients do not take their medication,” he added. “So what we were looking at is what happens if you actually decrease the frequency of medications even further? What if we go from once daily medication to once weekly?”
Researchers said they knew that this change would have an impact, especially in the areas where the Bill and Melinda Gates Foundation — which helped fund the research — is focused on, and especially when it comes to reducing the number of new HIV diagnoses.
Though the HIV mortality rate has decreased, it’s still an epidemic. Globally in 2016, 1.8 million people became newly infected with HIV and 1 million people died of AIDS-related illnesses.
With this capsule, researchers predicted, the effectiveness of HIV preventative treatment could increase by about 20 percent.
“Individuals at a higher risk of encountering virus take medication, and if they do, they’re better protected from a viral infection,” Kirtane explained. “In that kind of a scenario, we think that because of the introduction of a once-weekly medication we are coming up with, we can potentially save about 200,000 to 800,000 new infections over next 20 years — just in South Africa.”
The researchers previously launched a company called Lyndra to develop this capsule, which received a grant from the National Institutes of Health to continue this work with HIV and bring the technology to the patients.
But that’s not the end of this work — the researchers hope to develop once-weekly systems for even more conditions, from “neglected tropical diseases” to Alzheimer's, where patients can’t remember their medicine, to diabetes and even heart disease.
“Non-compliance is a problem across all medications,” Traverso said. “Simplifying the dosage really helps maximize the treatment.”
By The Numbers
prescriptions written annually in the United States, yet one in five are never filled
Of those filled, 50 percent of prescriptions are taken incorrectly — related to timing, dosage and frequency, according to the Centers for Disease Control and Prevention
people worldwide living with HIV/AIDS at the end of 2016.
people worldwide who newly became infected with HIV in 2016, or about 5,000 new infections per day
people who died from AIDS-related illnesses in 2016
total number of people who have died from AIDS-related illnesses since the beginning of the epidemic
people living with HIV were accessing antiretroviral therapy as of July 2017 — an increase from 15.8 million in June 2015 and less than one million in 2000