New injectable is a boon for HIV prevention

10 July 2020 - 16:53
Truvada was licensed in SA after the World Health Organisation recommended pre-exposure prophylaxis, or PrEP, as an additional HIV prevention choice. Now an injectable drug has proved to be even more powerful.
Truvada was licensed in SA after the World Health Organisation recommended pre-exposure prophylaxis, or PrEP, as an additional HIV prevention choice. Now an injectable drug has proved to be even more powerful.
Image: Epa/Maurizio Gambarini via The Conversation

If you want to protect yourself from HIV infection, but popping pre-exposure (PrEP) pills is not something you fancy, then having an injection may be an option in the near future.

The comes after new research showed that a long-acting injectable, which was tested locally, prevents HIV infection.

The HPTN 083 clinical trial, done by the US-based HIV Prevention Trials Network (HPTN),  is the first study to compare the efficacy of long-acting injectable cabotegravir (CAB) with the daily oral Truvada for HIV PrEP.

The trial enrolled 4,570 cisgender men and transgender women who have sex with men in seven countries including SA, Thailand and the US.

According to the interim data presented at the 23rd International Aids Conference on Tuesday, the injectable PrEP  is not just effective but also superior compared to the daily tablet form of PrEP.

Lead researcher Raphael Landovitz, from the University of California centre for clinical research and education, said oral treatment regimens were hard to maintain and a safe injection every two months “is an appealing alternative”.

He said the latest results not only demonstrated the superiority of the injectable PrEP, but also have the “potential to transform the landscape of HIV prevention for cisgender MSM (men who have sex with men) and transgender women”.

“We know some people have difficulty with or prefer not to take pills, and an injectable product such as long-acting CAB could be a very important option for them,” he said.

A total of 52 HIV infections occurred during follow-up, with only 13 infections in the injectable arm, representing an incidence rate of 0.4%.  About 39 or 1.22% of infections were in the tablet arm.  This equals three times the number of  HIV infections in the pill arm compared to the injection arm.

While both strategies reduced HIV risk among participants, Landovitz said the injectable strategy was more effective.

Prof Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said the HIV community is very keen to see the injectable PrEP made as widely available as possible.
Prof Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said the HIV community is very keen to see the injectable PrEP made as widely available as possible.
Image: Desmond Tutu HIV Foundation

“It’s great to see such a high level of efficacy in a potential additional HIV prevention option, and to see the high level of efficacy for an already available option, daily oral PrEP,” said Mitchell Warren, AVAC executive director.

“As we celebrate this exciting new data, we also must ensure that the companion HPTN 084 study of the same product in cisgender women finishes as quickly as possible, and simultaneously work to ensure broader access and support for daily oral PrEP in communities where it is needed now.

“We need options that will work in people’s lives, we need existing daily PrEP delivered at scale now, and we need multiple additional PrEP options to address diverse needs. CAB-LA, the dapivirine vaginal ring, and future products that show efficacy must be brought to market as quickly as possible,” said Warren.

In 2016, women aged 15 to 24 accounted for 37% of new infections, about four times greater than men their age.

To tackle this problem, in 2017 SA became the first African country to offer young women and adolescent girls an antiretroviral, Truvada, after research showed it was safe and effective to prevent HIV. However, stigma and name-calling, including women labelled as “sluts”, has resulted in many not using this pill.

Prof Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said the HIV community is very keen to see the injectable PrEP made as widely available as possible.

“We are keen to see it made available for all men having sex with men and transgender people worldwide, but cost will be a big factor.”

Meanwhile, in what researchers have labelled the “first possible case of an adult to achieve long-term remission” of HIV, researchers in Brazil are convinced they have arrested the virus without a bone-marrow transplant.

In a study that administered intensified multidrug antiretroviral therapy with twice-daily nicotinamide for 48 weeks to five individuals to determine if these regimens would be able to achieve an HIV cure, a 34-year-old Brazilian man who was diagnosed with HIV in 2012 has maintained long-term remission without taking any ARVs.


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