Major change is coming – long-acting HIV pre-exposure prophylaxis

A long-acting injectable formulation of the HIV drug cabotegravir has been developed for the prevention of HIV. In well-designed clinical trials, long-acting cabotegravir (LA cab) has been found to be highly effective at reducing the risk of HIV infection. Furthermore, LA cab has been found to be superior to daily oral tenofovir DF + FTC (a combination sold as Truvada and available in generic formulations).

When HIV drugs are used prior to exposure to prevent infection, this is called pre-exposure prophylaxis (PrEP). LA cab represents the first long-acting formulation of PrEP that has been found to be highly effective. Initially people who are interested in getting LA cab injections first take the oral formulation of cabotegravir every day for several weeks (one 30 mg pill of cabotegravir daily). Doctors then switch patients to injections of LA cab once monthly for two consecutive months. Injections are given deep into the buttocks. After this initial injectable dosing, LA cab is given every two months.

Due to its infrequent dosing, LA cab has the potential to change the way PrEP is used. Some people do not wish to use daily oral PrEP, or have difficulty taking pills or remembering to take pills. In such cases, injectable long-acting PrEP in the form of LA cab could meet their HIV prevention needs.

LA cabotegravir has been approved in the U.S. and the European Union, but it is not likely to be approved in Canada for HIV prevention until late Spring 2024.

When LA cab is approved in Canada, there will be much to learn from how it has been implemented in other countries. Due to its high rate of effectiveness in clinical trials, there is hope that if LA cab is used in populations at high risk for HIV, it has the potential, along with regular HIV testing, to help further reduce the spread of HIV. Regional and local public health authorities, clinics, healthcare providers and community organizations will have to determine in the months and years ahead how best to deploy LA cab to reduce the spread of HIV infection.

LA cabotegravir is the first long-acting formulation of PrEP. In a few years, it is likely that another long-acting formulation for PrEP will become available—long-acting lenacapavir. This other formulation requires injection just under the skin of the abdomen every six months.

In this issue of TreatmentUpdate, we present information on LA cab from clinical trials and an important case report. This information may be useful for clinicians and people interested in this new technology for HIV prevention.

—Sean R. Hosein