HIV treatment has seen significant advancements in recent years, with new therapies offering more options for people with HIV. In the Netherlands, both long-acting injectable (LAI) and new oral HIV treatments are gaining interest. Physicians carefully assess various factors, including efficacy, side effects, and patient preference, when recommending treatment options. However, implementing new therapies presents challenges, from increased healthcare demands to physician assumptions about patient preferences. In this article we explore the current state of HIV treatment in the Netherlands, key considerations for physicians, and future developments in HIV care together with Prof. Marc van der Valk, internist-infectiologist, Professor of Internal Medicine, topic leader of the HIV, viral hepatitis & STI’s topic, part of the Infectious Diseases program of the Amsterdam institute for Immunology and Infectious diseases, chairman of the board of Stichting hiv monitoring (SHM), and HIV treatment specialist at the Amsterdam UMC.
Current usage and trends in HIV treatment
In the Netherlands, around 600 people currently use the long-acting injectable (LAI) HIV treatment combination of cabotegravir and rilpivirine, while approximately 1,800 individuals use the oral HIV treatment doravirine. Since their introduction—doravirine in 2018 and LAI cabotegravir and rilpivirine in 2021—these treatments have been increasingly prescribed. Dutch HIV physicians are well-informed about guideline-recommended options, ensuring a steady integration of new therapies into practice.
Key considerations in treatment selection
The primary factor in selecting an HIV treatment is its effectiveness in suppressing the virus. Physicians may also switch a patient’s medication due to side effects or drug interactions. Additionally, patient preference plays a significant role, particularly with LAI therapy, which is administered bi-monthly. This option for instance appeals to individuals who prefer not to take daily medication.
Contraindications and risk factors
Not all patients are suitable candidates for LAI or doravirine treatment. Some individuals have a virus resistant to these drugs or have experienced adverse reactions to similar medications in the past. For LAI therapy, the use of blood thinners is a clear contraindication, and physicians must carefully consider potential interactions with other chronic medications.
Challenges in implementing LAI treatment
Two challenges play a significant role in the implementation of LAI treatment options. One of the key challenges in implementing LAI therapy is the increased demand it places on healthcare resources. Unlike oral treatments, which typically require only two annual check-ups, LAI therapy involves six medical appointments per year. This places a significant burden on both people with HIV and healthcare providers.
Another challenge stems from the assumptions some HIV physicians make about their patients’ preferences. Despite being well-informed about guideline-recommended treatment options, doctors may believe they can predict whether a patient would be interested in a new therapy and might not always present all available options. Research led by Prof. van der Valk, Dr. Pythia Nieuwkerk and PhD candidate Kyra Mendes de Leon at Amsterdam UMC aims to better understand the factors that influence patient decision-making in HIV treatment selection, emphasizing the importance of open discussions between physicians and patients.
The Dutch approach to new HIV therapies
Dutch HIV physicians are generally quick to integrate new guideline-recommended treatments into practice. As a result, the Netherlands is at the forefront of conducting nationwide observational studies on new HIV therapies (link naar artikel 1), providing valuable data to inform future treatment strategies.
Future developments in HIV treatment
Looking ahead, several developments will shape HIV treatment in the Netherlands:
- Expansion of Long-Acting HIV medications: in the coming years, more variations of long-acting HIV medication are expected to become available.
- Hiv prevention innovations: long-acting PrEP injections are expected to become available soon, with dosing intervals of 2, 6 or even 12 months.
- Progress toward an HIV vaccine and cure: research efforts, including those at Amsterdam UMC, are intensifying to develop an HIV vaccine and potential cure.
The impact of PEPFAR cuts
A major concern in global HIV treatment is the recent decision by U.S. President Donald Trump to halt funding for USAID’s PEPFAR (President’s Emergency Plan for AIDS Relief). Since 2003, PEPFAR has invested $110 billion in HIV treatment and prevention across nearly 50 countries, saving an estimated 25 million lives, providing HIV treatment to 20 million people worldwide, testing 71 million people for HIV, and allowing 5.5 million children of mothers with HIV to be born HIV-free. Additionally, more than 2 million people have started HIV prevention with PrEP through PEPFAR. The abrupt discontinuation of this funding has devastating implications, with projections indicating 650,000 additional HIV-related deaths in South Africa alone over the next decade. While the immediate effects may not be felt in the Netherlands, the medium-to-long-term impact on global HIV research and treatment accessibility will be substantial.
Text: Esmée Vesseur (AI&I) and Sacha Boucherie (SHM)
Photo credits: Monique Kooijmans
Learn more about the collaborative HIV research of Stichting HIV Monitoring and the Amsterdam institute for Immunology and Infectious diseases:
Progress and Challenges in HIV Care for Transgender Women in the Netherlands: Insights from an 11-Year Study (October 2024)
Despite access, one-third of people with HIV and hepatitis C (HCV) not treated for HCV (April 2023)
Improved survival by screening for anal cancer precursors in people with HIV (January 2023)