No more daily pills? PrEP may soon be available as an infrequent injection.

By Barrett White

Tired of the blue pill? A new, more effective version is on the way – and you don’t have to take it daily.

 

We have long touted PrEP as the best tool in our toolkit for ending the HIV epidemic. This sentiment remains true, and with new drugs on the horizon for the prevention of the spread of HIV, we remain optimistic. PrEP as it is currently available is simple enough: take one pill per day and the spread of HIV through unprotected sex is prevented up to 99% of the time, according to the CDC.

But what if it were even easier than that?

Soon, we may be able to ditch the pills altogether and opt for an injection at the doctor’s office. No more daily regimen, and for those who prefer discretion, no more pill bottle on the bathroom counter.

“The shot is long acting – or ‘LA’ – Cabotegravir, an integrase strand inhibitor, which has been shown in two large clinical trials to have superior efficacy to Truvada,” says Dr. Natalie Vanek, infectious disease expert at Legacy Community Health and Chair of the Texas HIV Medication Advisory Committee. “Its half-life, given as an injection, is 21 to 50 days.”

Because of this long half-life, the dosing of the new “PrEP shot” is anticipated to be as follows:

• Week 1: 2ml intramuscular (IM) injection
• Week 4: 2ml IM injection
• Week 12: 2ml IM injection
• Week 20: 2mL IM injection, and then continue dosing every 8 weeks

One shot, every two months, and we can help end the HIV epidemic.

Dr. Vanek continues, “The injection has been studied in ‘men who have sex with men’ (MSM), transgender women, and in cisgender women. If approved, it will provide another option for all those wishing to practice safe sex.”

ViiV Healthcare Limited, the pharmaceutical company producing the drug, submitted a new drug application to the FDA, which is currently under review. Dr. Vanek is hopeful that we might hear an FDA decision by late 2021 or early 2022.

The efficacy is clear, too, says Dr. Vanek. The two large National Institutes of Health (NIH) clinical trials, named HPTN 083 and HPTN 084, found superior efficacy of Cabotegravir versus Tenofovir/Emtracitibine, which you may know by its more common name, Truvada.

HPTN 083 studied MSM and transgender women, while HPTN 084 studied cisgender women. Both studies found Cabotegravir to be more effective in these groups. “For example, in HPTN 084, which studied Sub-Saharan African cisgender women, there were 38 new HIV infections total, but only 4 occurred in women using Cabotegravir, versus 34 in the women using Tenofovir/Emtracitibine, or Truvada.”

Regarding pricing, Dr. Vanek remains hopeful that the new drug will be just as available as PrEP is today. “At this time, we just do not know yet about drug pricing. I expect the price to be comparable [to PrEP currently] or else it would not be widely used.”

Noted side effects are minimal: swelling or pain at the injection site (your gluteal area), and headaches. For those who opt to switch from the pill, injections could be administered by a doctor’s office, hospital-based clinics, or in pharmacies that have private rooms (due to the location of the injection).

Legacy is committed to ending the HIV epidemic, and with every advancement we get one step closer. Talk to your Legacy provider about what to expect when Cabotegravir hits the market. To schedule an appointment, visit our online appointment scheduling tool or call (832) 548-5000.