Currently in the US, there are two drugs approved for prevention of HIV or PrEP (Pre-Exposure Prophylaxis).
Truvada (a combination of tenofovir and FTC) is approved for women and men and Descovy (a combination of tenofovir alafenamide and FTC) is approved for men.
In most parts of the world, only Truvada is available which is a pill taken daily. It works very well in preventing HIV when it is taken as prescribed!
When people don’t take the drug properly, there may not be enough drug present in the blood to prevent an HIV infection.
Since many people don’t like taking medicines, especially when they don’t have a disease, it would be great if there was an option that didn’t require daily dosing.
In a post on June 1, 2020 in the HIV/AIDS section on this site, I reported the very encouraging results of a treatment, long-acting cabotegravir injectable in preventing HIV in men (Long-acting medication for HIV Treatment and Prevention).
I mentioned at the time that there was a companion study that was ongoing at that time being conducted in women.
In the recent study, a double-placebo study design was used where women subjects received either the real Truvada pill and a “fake” injection or a real injection of cabotegravir and “fake” Truvada pills.
The study subjects did not know which treatment they were actually getting. 3,223 sexually-active women who were confirmed HIV-negative were recruited across several eastern and southern African countries.
The pills were taken daily whereas the injection was given once every two months. In the study, there were 38 women who got infected. First, the good news.
For the group taking the daily Truvada, there were 34 infections, or an incidence rate of 1.79%. If we compare this result to studies where there are some subjects that get no treatment, the infection rate averages 4.5 – 5.0% in that group.
This means that Truvada could potentially
reduce the risk to HIV infection as much as 2.5 – 3.0 -fold, probably higher if the subjects were all taking the medicine. But there is even better news.
For the group who received an injection of cabotegravir every two months, there were four infections, or an incidence rate of 0.21%. This is superior protection with the cabotegravir injection compared to the daily-oral Truvada.
This study is extremely important for a number of reasons. Young African women are among the groups at highest risk for HIV infection in the world. In many settings, it is difficult for women to negotiate safe sex practices (i.e. use of condoms) with their male partners.
There are also unacceptable rates of sexual violence against women by their partners. Further, in impoverished communities, sex work is used as a source of income.
Women struggling to make ends meet may have to choose between requiring their clients to use condoms or accepting clients who will pay many times more not to use them.
So the need for PrEP is urgent, but the use of oral PrEP (i.e. Truvada), can be stigmatizing. People often do not understand that the person taking HIV meds doesn’t have HIV but is actually protecting themselves from getting it.
An injection with cabotegravir that is taken every two months appears to provide unparalleled protection and circumvent other problems common with PrEP.
So now, we have shown that injectable cabotegravir can effectively protect against HIV infection in men and women with a single injection every two months.
This medicine could be a real game-changer in preventing HIV infection worldwide. Now, the biggest hurdle will be the cost of the medicine. While it is more effective than Truvada, it almost certainly will cost more.
Who will cover the costs in Africa, Asia and Latin American countries? Will insurances in the US cover the cost? Time will tell. Stay tuned!
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