Physician poll finds ultralong-acting regimens and home administration could transform HIV market

Ultralong-acting regimens and home administration could rapidly shift the HIV market away from daily orals as the sector enters its “last cycle of innovation,” according to physicians surveyed by analysts at Jefferies.

Companies including Gilead and GlaxoSmithKline are racing to free HIV patients from the need to take medicines every day and thereby improve compliance and quality of life. The FDA approved Cabenuva, from GSK’s ViiV Healthcare, for administration every two months earlier this year, and work is underway to further extend the window between doses. Analysts see demand for longer-acting treatments. 

“Results from our proprietary survey indicate that further innovation in long-acting (LA) regimens in the form of ultra-long acting regimens or home administration has the potential to rapidly shift the treatment paradigm away from daily orals. We believe these second-generation LA regimens likely represent the last cycle of HIV treatment innovation,” analysts at Jefferies wrote in a note to investors. 

The analysts based their assessment on the results of a poll of physicians, specifically a question about the predicted impact of self-administered regimes and treatments that last three to six months. The polled physicians expect three to six month regimens to have the biggest impact, predicting they could trigger an almost 70% increase in switching from daily orals. Physicians estimate a self-administered LA regimen could trigger a 40% rise in switching. 

If accurate, the findings point to the potential for the market to change quickly as new treatments come to market. According to the physicians, Gilead’s Biktarvy accounts for around 60% of new to treatment patients. However, despite Gilead’s current dominance, the survey results led the analysts to argue there is “all to play for” as the HIV sector enters what they expect to be its “last cycle of innovation” from 2028 onward. 

A series of stepping stones stand between the sector and that transformation. At GSK, Cabenuva growth is part of the process. The Jefferies analysts are bullish on the drug’s mid-term prospects but expect a slower ramp up than some of their peers. 

“We are cognizant of Cabenuva's early adopters, particularly for patients who are passionate about moving away from daily orals due to stigma or lifestyle habits, but would argue we need to see a sales inflection this year to provide confidence that the switch market is beginning to normalize after pandemic lockdowns and the prescriber base of physicians is increasing,” the analysts wrote.