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Promises and challenges: cabotegravir for preexposure prophylaxis
Matthew A Spinelli1, Beatriz Grinsztejn2, Raphael J Landovitz3
1Division of HIV, ID, and Global Medicine, University of California, San Francisco, California, USA.
Current Opinion in HIV and AIDS
|June 28, 2022
Summary
Injectable cabotegravir-based pre-exposure prophylaxis (PrEP) offers higher HIV prevention effectiveness than daily oral PrEP. Implementation requires addressing challenges like monitoring and accessibility for widespread use.
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- Oral tenofovir-based pre-exposure prophylaxis (PrEP) has reduced HIV incidence but disparities persist.
- Injectable cabotegravir-based PrEP presents an alternative for individuals with adherence issues or preference against daily medication.
Purpose of the Study:
- To review the efficacy, promises, and challenges of cabotegravir-based PrEP.
- To evaluate cabotegravir's role in expanding HIV prevention options.
Main Methods:
- Review of randomized trials comparing injectable cabotegravir-based PrEP with oral PrEP.
- Analysis of effectiveness data in key populations, including men who have sex with men (MSM), transgender women, and cisgender women in sub-Saharan Africa.
Main Results:
- Cabotegravir demonstrated significantly higher effectiveness in preventing HIV incidence compared to oral PrEP in trials.
- High effectiveness was observed in populations with disproportionate HIV burden, including MSM, transgender women, and cisgender women.
- Rare breakthrough infections with cabotegravir were associated with delayed diagnosis using antigen/antibody tests and rare instances of resistance.
Conclusions:
- Cabotegravir-based PrEP is a highly effective additional option for HIV prevention.
- Successful implementation necessitates developing strategies for streamlined and accessible delivery in real-world settings.
- Challenges include the need for HIV RNA monitoring, additional clinic resources, and managing dosing interruptions.
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