10 October 24
Ending HIV
Research update: Long-acting injectable PrEP
Long-acting injectable PrEP has seen some remarkable results in recent clinical trials, with Lenacapavir presenting two sets of exciting results demonstrating its effectiveness in preventing HIV. Though this is still an emerging prevention strategy, questions around affordability may mean a wait before we can see this or other forms of long-acting injectable PrEP become available in Australia.
What is long-acting injectable PrEP?
Long-acting injectable PrEP is a long-lasting injectable form of antiretroviral medication, like what you find in existing oral pills, but formulated to stick around in the body and provide ongoing protection.
One of the key benefits of long-acting PrEP is that it can be administered discreetly in private with a doctor. So if you’re in a situation where your taking medication might lead to unwanted questions about your sex life, long-acting injectables could be a great solution.
Long-acting injectable Cabotegravir approved but not subsidised
Previous research developments have led to the approval of the drug Cabotegravir for use as PrEP in Australia. Cabotegravir is capable of protecting against HIV for up to two months at a time before a follow-up dose is required.
Unfortunately in June this year, it was announced that the Pharmaceutical Benefits Advisory Committee (PBAC) and ViiV, the drug manufacturer had not been able to successfully negotiate a price subsidy, which would bring the cost of the drug within reach of most people in Australia.
Although Cabotegravir is not functionally available for use as PrEP, we can take heart that it is already helping those living with HIV and is an available form of HIV treatment. Instead of a single drug, it’s a combination of Cabotegravir and Rilpivirine and is marketed under the brand name Cabenuva.
Long-acting injectable Lencapavir shows extremely promising results in new study
In what’s been an eventful year for HIV prevention, a second form long-acting injectable PrEP Lencapavir has made the news showing very promising results. The PURPOSE 2 trial has found Lenacapavir (a twice-yearly injection) to have reduced HIV infections by 96% among its cohort of over 3,200 cis and trans men, trans women, and non-binary people who have sex with men.
It’s a rare occurrence that any new drug has such a high rate of efficacy, protecting 100% of the cohort that was assigned to take Lencapavir from HIV transmission. This outstanding result led to the early closure of the trial and gave 2,134 young women and adolescent girls in South Africa access to Lencapavir, with the remainder of the study participants receiving either Descovy or Truvada. This is no doubt a wonderful outcome for the trial participants, but also it shows great promise to be a new tool to fight HIV worldwide.
While the trial is not yet complete, Lencapavir was found to be so effective that they decided to stop the blinded testing of the trial and give access to all participants who were previously receiving another drug. While these interim results have been released, the trial continues across several countries including Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.
This outcome follows on the tail of the PURPOSE 1 study, whose early results showed a possible 100% efficacy rating, given that there were zero HIV transmissions in the group taking Lenacapavir, of over 2,100 South African and Ugandan cis women.
It’s a rare occurrence that any new drug has such high rates of efficacy and no doubt a wonderful outcome for the trial participants, but what comes next will determine who gets to access this exciting new prospect.
What comes next and the future of PrEP
The desire for this new form of PrEP is already here, with PrEP users in Australia expressing they would prefer to take long-acting forms of PrEP over daily pills.
Gilead, the trial sponsor and drug manufacturer of Lenacapavir, has announced plans to use the data from the two trials to begin the process of global regulatory filings, though the question remains what price this potentially groundbreaking drug will be available at? This will be one of the primary factors determining whether or not we’ll be able to access Lenacapavir down under, especially while we have cost-effective oral pills already available.
While we wait for further updates on this potential new form of PrEP, we’ll have to hold on to our PrEP pills for a little while longer. However, if you want to have a taster of taking your PrEP less frequently, you could try on-demand dosing instead of daily right now!
On-demand dosing means you take it just before you’re expecting to have sex and for two days following your last risk of exposure. This can greatly reduce how often you’re taking pills thereby making it cheaper! Be sure to follow the on-demand dosing guidelines to take it safely.
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