HIV prevention may require only two injections per year

Zero: This is the number of new HIV infections among young women and teenage girls who took a preventive medicine twice a year.

Researchers tested a new formulation of pre-exposure prophylaxis, or PrEP, in a clinical trial of HIV-negative women and adolescent girls aged 16 to 25 in South Africa and Uganda. The Phase III trial compared a twice-yearly injection of the antiviral drug lenacapavir with a widely used daily PrEP pill containing two different antiviral drugs.

There were no new infections among more than 2,100 women and girls who received lenacapavir twice a year, researchers from pharmaceutical company Gilead Sciences report online July 24 at. New England Journal of Medicine. There were 16 new infections among nearly 1,100 taking the daily PrEP pill Truvada, the first PrEP option, which became available in 2012. The trial results were also presented July 24 at the 2024 International AIDS Conference in Munich.

Young women and adolescent girls from sub-Saharan Africa are among the groups at high risk for HIV infection. Of the 4,000 young women and adolescent girls aged 15 to 24 who became infected with HIV globally every week in 2023, on average, about 75 percent were from sub-Saharan Africa, according to the Joint United Nations Programme. for HIV/AIDS.

Studies have found that young women and teenagers are open to PrEP, but that there are barriers to using preventive medicine. The stigma surrounding HIV casts a shadow over PrEP. Some women are afraid that while taking the drugs others will assume they are HIV positive (SN: 12/1/20). And the daily pill regimen can be difficult to keep up with.

PrEP use, particularly ongoing and ongoing use, is challenged by HIV-related stigma from partners, peers and the community, limited understanding or acceptance of their risk, and imperfect provider knowledge and communication, says Amrita Rao, an epidemiologist at the Johns Hopkins Bloomberg School. of Public Health who was not involved in the new study. Getting a shot twice a year can make it easier to maintain protection, she says.

In 2021, the US Food and Drug Administration approved a monthly injectable PrEP, an injection of the antiviral drug cabotegravir. But the prohibitive cost has so far kept it off the table for low- and middle-income countries. This year, the US Presidents Emergency Plan for AIDS Relief supplied the cabotegravir PrEP shot to Malawi, Zambia and Zimbabwe.

The twice-yearly injection may mean easier adherence and fewer clinic visits, Rao says, but the exchange may reduce testing and counseling opportunities for patients. However, having an additional choice and the ability to choose the method that is best for you is a welcome development.

But a recurring theme of PrEP’s rollout has been long delays between drug approval and real-world delivery to those most in need, Rao says. Without thinking about the implementation of the strike twice a year, even this very promising tool may not realize its full benefit.