Research Update: Long-acting injectable PrEP approved for HIV prevention

Prevention in Focus PiF 2024 Fall

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Health Canada recently approved the use of the drug cabotegravir (Apretude) as the first long-acting form of pre-exposure prophylaxis (PrEP) to prevent HIV infection. Until now, PrEP has been available as pills taken daily or on demand. Oral PrEP is highly effective at preventing HIV when taken as prescribed. 

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When taken as PrEP, long-acting cabotegravir is injected by a healthcare provider every two months, after the first two injections are given in consecutive months. Some people take cabotegravir pills for up to a month before starting injections. This formulation was found to be highly effective at preventing HIV in two large clinical trials conducted among people at risk for HIV (one trial among cisgender men who have sex with men and transgender women,1 and one among cisgender women2). In both studies, long-acting cabotegravir was found to be more effective than oral PrEP, probably because injections do not require adherence to pill-taking. 

Long-acting injectable PrEP has the potential to expand the number of people who use PrEP by providing another option for HIV prevention. It may offer benefits to some PrEP users, such as adherence support and increased confidentiality.3 Health Canada approval is a first step toward making this intervention available in Canada; access and coverage by insurance plans will evolve over time. 

References

  1. Landovitz RJ, Donnell D, Clement ME et al. Cabotegravir for HIV prevention in cisgender men and transgender women. New England Journal of Medicine. 2021 Aug 12;385(7):595-608.
  2. Delany-Moretlwe S, Hughes JP, Bock P et al. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial. Lancet. 2022 May 7;399(10337):1779-1789.
  3. Grace D, Gaspar M, Wells A et al. Injectable pre-exposure prophylaxis for HIV prevention: perspectives on the benefits and barriers from gay, bisexual, and queer men and health system stakeholders in Ontario, Canada. AIDS Patient Care and STDs. 2023 Jun;37(6):306-315.

 

About the author(s)

Camille Arkell is CATIE’s manager, harm reduction, HIV prevention and testing. She has a Master of Public Health degree in Health Promotion from the University of Toronto and has been working in HIV education and research since 2010.