Long-Acting ART Injectables as HIV PrEP: Key Discussions and Developments

ViiV Healthcare's Long-Acting ART Injectables for HIV Prevention Discussed at ESCMID Global Conference

On May 8, 2024, the ESCMID Global conference in Barcelona witnessed discussions about the use of long-acting ART injectables as PrEP for HIV prevention in Europe and Central Asia. The usage of PrEP varies significantly across countries, with high usage in the UK, France, Germany, and Spain, but low usage in Armenia, Lithuania, and Tajikistan. ViiV Healthcare's long-acting cabotegravir (CAB-LA) injectable, administered every eight weeks, has shown promising results in preventing HIV infections. However, experts suggest that even longer-acting PrEP options would be beneficial, and drug developers are investing in developing such formulations.

Key Takeaways

• PrEP usage varies widely across European and Central Asian countries, with high usage in the UK, France, Germany, and Spain, and low usage in Armenia, Lithuania, and Tajikistan.
• ViiV Healthcare's long-acting injectable cabotegravir (CAB-LA) is an additional HIV prevention option, recommended by WHO, that could help close gaps in HIV prevention in the region.
• CAB-LA has shown significant advantages over oral PrEP in clinical trials, with a 66% reduction in HIV infections in one study and an 88% reduction in another.
• Key opinion leaders emphasize CAB-LA's potential for improving adherence and offering a discreet, stigma-free option, but note that some patients may still find the bi-monthly injection schedule demanding.
• Developers are investing in longer-acting PrEP options, such as ViiV Healthcare's CAB-ULA with potential for dose intervals of at least four months, and Gilead's lenacapavir, which is being investigated as a twice-yearly subcutaneous injection for PrEP.

Analysis

The disparity in PrEP usage across European and Central Asian countries, with low usage in Armenia, Lithuania, and Tajikistan, highlights the need for accessible and effective HIV prevention measures. ViiV Healthcare's CAB-LA injectable, recommended by WHO, offers advantages over oral PrEP, with significant reductions in HIV infections. However, the bi-monthly injection schedule might still present challenges for some patients. The development of even longer-acting options, like ViiV's CAB-ULA and Gilead's lenacapavir, could further improve adherence and reduce stigma. This progress may lead to increased PrEP usage, impacting healthcare organizations, pharmaceutical companies, and ultimately, reducing HIV infection rates in the region.

Did You Know?

• PrEP (pre-exposure prophylaxis) usage varies widely across European and Central Asian countries: PrEP is a preventive measure for people who do not have HIV but are at risk of infection. It involves taking antiretroviral medication to reduce the risk of acquiring HIV. The variation in usage could be due to factors such as accessibility, affordability, and awareness.
• ViiV Healthcare's long-acting injectable cabotegravir (CAB-LA): CAB-LA is an injectable form of PrEP, developed by ViiV Healthcare, that is administered every eight weeks. It has shown promising results in preventing HIV infections, with a 66% reduction in one study and an 88% reduction in another. The WHO has recommended CAB-LA as an additional HIV prevention option.
• Longer-acting PrEP options: Developers are investing in creating even longer-acting PrEP options to further improve adherence and convenience. ViiV Healthcare's CAB-ULA is a potential candidate, with the possibility of dose intervals of at least four months. Gilead's lenacapavir is also being investigated as a twice-yearly subcutaneous injection for PrEP. These developments could help address the challenges of adherence and stigma associated with current PrEP regimens.