From multiple pills per day to one treatment per month: progress in HIV medication made possible by pharma collaborations

Share this article

African man and woman looking at a phone
Unprecedented collaborations between different pharmaceutical companies have resulted in extraordinary progress for HIV patients over the past four decades. From the first ever treatments, to single pills and now even long-acting injections, treatment options have come a long way. In this interview, Dr. Theresa Pattery (Head of Disease Management Programs at Janssen Pharmaceutica) tells us of this long journey and talks about the role of drones and phones in the world-wide fight against HIV.

Early in the 1980s, a mysterious virus started to circulate from which people failed to recover, and HIV suddenly became one of the most challenging health issues of our time. Dr. Paul Janssen and the Janssen Research Foundation took up the challenge to find a solution to this devastating disease. They first started a partnership with the Rega Institute (KU Leuven) to screen for anti-HIV compounds. In the 1990s, the Janssen Research Foundation also joined hands with a company called Tibotec-Virco, which was on the verge of developing a HIV treatment of its own. This company had been co-founded by Belgian biotech legend Dr. Rudi Pauwels and Dr. Paul Stoffels (who went on to become the CSO Johnson & Johnson), and was acquired by Johnson & Johnson in 2002.

Dr. Theresa Pattery worked for Tibotec-Virco before starting her career at Janssen, where she’s now been involved in R&D for over 20 years. She recalls: “In the late 1990s, HIV-patients had to take a handful of medications in the morning, afternoon, and night. This was a very hard treatment regimen for patients to adhere to.”

“The biggest success for HIV to date is the fact that many pharmaceutical companies have been working together to tackle it. Through these successful collaborations, we’ve managed to develop this one-pill-per-day treatment.” – Theresa Pattery

In 2006, Janssen’s first HIV medicine received FDA approval. This quickly led to a partnership with Gilead and ViiV Healthcare (a spin-off from GSK), to create a single-tablet, multi-drug HIV treatment in 2011. “Today, patients on first-line HIV treatment only need to take one pill, once a day, containing a combination of three medications from different companies,” continues Pattery. “The biggest success for HIV to date is the fact that many pharmaceutical companies have been working together to tackle it. Through these successful collaborations, we’ve managed to develop this one-pill-per-day treatment.”

In 2020, an even bigger milestone for HIV-treatment was achieved, when a collaboration between Janssen and ViiV Healthcare led to the development of a long-term injectable treatment regimen. This progress means that patients only need a monthly or even bimonthly injection to keep HIV under control. Pattery elaborates on the huge impact this has for patients: “We call this long-acting injection CARLA. The beauty of this treatment is that it frees patients up from needing to think about HIV on a daily basis. Imagine you are an HIV-positive teenager, for example: with this treatment, you can have a normal life, have fun, and make friends, without a constant reminder of the disease.”

The future is here: phones and drones in the fight against HIV

In addition to developing new treatment options in collaboration with other companies, Janssen is also contributing to improved global access to HIV medication to minimalize the spread of the virus. “A first-line treatment with one pill per day costs 75 US dollars per patient per year, which is feasible in for example Africa, where the cost would otherwise be a barrier,” says Pattery. “If the patient adheres to the first-line treatment regimen, HIV is virologically suppressed. This means that they have less than twelve copies of the virus per milliliter of blood plasma. Even if these patients have sexual activity without condoms, they don’t transmit the virus to their partner.” Together with UNAIDS, Janssen wants to keep all patients on first-line treatments as long as possible. The target is the 90-90-90 principle: at least 90% of people with HIV need to be diagnosed, of which 90% need to be on treatment, and of which 90% need to achieve viral suppression. “The next step is achieving the more ambitious target of 95-95-95,” adds Pattery.

“We actively engage with the community and try to understand where the logistical gaps are.” – Theresa Pattery

To stay in touch with patients and make sure they adhere to their HIV treatments, Janssen makes use of the fact that 80-90% of people in Africa now possess a phone, with old second-hand phones being resold all over the continent. “The numbers on the buttons are scratched out, but people know how to use them,” explains Pattery. “We can call the patients in their local language and send them pill reminders. The phones can also be used to educate patients on how they can protect themselves and others. They learn about stigmatization. We treat them with dignity and respect, and because of this, they feel inherently motivated to adhere to their treatment.”

Read this article to find out how UZ Gent researchers identified HIV’s hidden ‘viral reservoir’ in the body!

In geographically isolated areas, logistical challenges also pose a threat to treatment adherence. Janssen is involved in multiple projects aiming to get medications to the patients who need them on time. “For example, in the mainland of Uganda, the HIV-infection rate is 6%, but on the islands of Lake Victoria where the fisher folk live, the infection rate is 25-30% per year. The main reason for this difference is that they don’t have easy access to HIV-medication,” Pattery explains. “We actively engage with the community and try to understand where the logistical gaps are. Boats with medications have been sent to those islands, but sometimes the boats capsize, and the medication never arrives. We have been collaborating with the Ugandan government-run Infectious Disease Institute to launch the medical drone project. With drones, we now can fly the drugs to the right spots at the right time, and we see very positive results.”

Prioritizing health, not competition

The progress we have witnessed in the evolution of HIV treatment and prevention has been one of the most successful examples of how collaboration between pharmaceutical companies and other organizations can directly improve patient lives. “To develop a treatment for HIV, pharmaceutical companies worked together instead of against each other. Fantastic results have been achieved, and this should serve as an example for other disease fields,” concludes Pattery. “When you look to oncology or immunology, for example, collaboration is not yet present on the same level. My hope for the future is that companies in other fields will collaborate much more and develop great treatments too.”