The future of HIV prevention is a choice: pills, rings, jabs

• South Africa has exceeded its goal of deploying HIV prophylaxis in 2020, despite the coronavirus pandemic.
• Eight-week injections to prevent HIV have been shown to be more effective than pills in two large trials, but are awaiting regulatory approval worldwide.
• The deployment of injections must be a global effort to avoid creating silos for each new HIV prophylaxis

South Africa has Africa’s largest and fastest-expanding HIV prevention pill program, with more than 100,000 new users of tablets between July 2016 and December 2020 (pre-exposure prophylaxis (PrEP)). ) Is recorded. Presented data At this week’s International AIDS Society HIV Prevention Research Conference.

South Africa was the first country on the continent Approve PrEP in 2015 Launched Pilot PrEP Program Among Sex Workers at 2016..The country seems to be far beyond that goal National HIV Plan, By 2022, we aim to provide HIV prophylaxis to more than 104,000 new users of the high-risk group.

The country is still below the 2020 PrEP target set by the President’s AIDS Relief Emergency Fund, Pepfer.Pepfer is coming soon 200,000 in total User – Twice as high as the local target.

PrEP tablets are made up of two antiretroviral drugs (drugs used to treat HIV) (tenofovir and emtricitabine) and are called torubadas. Taken daily can reduce the chances of people getting HIV through sex by up to 96%. Research has It is shown.

how? According to a survey High enough level Of these two drugs in the vaginal or anal tissue of HIV-negative individuals, the drug can most often prevent immune system cells from becoming infected with HIV when exposed to the virus.

2019, Researcher discovered Take 2 tablets 24 hours before sex and 3 tablets 1 day after sex It worked as well to prevent infection..

Despite the coronavirus pandemic, new oral PrEP users around the world reached a record number in 2020. Experts argue that it is important that this success be maintained in 2021 and used strategically to obtain other new preventive options such as vaginal rings and 8-week injections. People too.

A silicone ring inserted into the vagina releases the antiretroviral drug dapivirin into the wearer’s blood and can be replaced monthly at home.

Women can reduce their risk of getting HIV by about one-third And was Approved For cisgender women by the European Medicines Agency last year. South Africa has not yet approved the device.

Currently, injections of the long-acting antiretroviral drug Cabotegravir may be given once every eight weeks.

Safe and effective

The results of the HPTN084 trial presented at the conference showed that jabs are even more effective than turvada for cisgender women.In the previous exam Researchers also announced in 2020 that Cabotegravir is more effective than oral PrEP in men who have sex with men and transgender women...

In the HPTN084 trial, in which one group of participants received torubada and other cabotegravir, women who received cabotegravir injections had an 89% lower risk of HIV infection than women who received torubada.

The study was conducted on more than 3,000 HIV-negative women in 20 locations in seven countries in sub-Saharan Africa, including Botswana, Kenya and South Africa.

Overall, less than 1% of study participants were infected with HIV during the course of their studies. [Truvada and cabotegravir] Sinead Delany-Moretlwe, lead author of the University of the Witwaters Reproductive Health and HIV Institute, explains Sinead Delany-Moretlwe, the lead author of this study.

In 2020, a group of independent experts who reviewed the study recommended that the blind phase of the study be stopped early, as the drug proved to be very safe and effective.

In other words, participants who were initially given a dummy injection of Cabotegravir in combination with oral preparation had sufficient evidence that the injection was working and instead gave the actual Cabotegravir injection for the rest of the study. Given.

So why do Cabotegravir injections work better than Torvadapill to prevent people from becoming infected with HIV?

Delany-Moretlwe says the answer is probably medication compliance. Remembering to take pills daily is more difficult than taking jabs every eight weeks.

Studies have shown that the less frequently you take PrEP pills, the less effective they are.

A 2015 studyHowever, South African women have demonstrated their willingness and ability to take PrEP pills daily. Three-quarters of the young women who participated in the exam adhered to their daily regimen.

However, Mitchell Warren, secretary-general of the AIDS Vaccine Advocacy Union (Avac), a US-based advocacy group, says more options are always better.

And potential HIV prevention options are expanding rapidly. Scientists are studying HIV prophylaxis that can be taken monthly rather than daily. It is made of islatravir, a long-acting antiretroviral drug.

More choices

So far, according to a study presented at this week’s conference, scientists know that pills are well tolerated and that monthly doses produce enough levels of drugs in people’s systems to prevent HIV infection. More, says Sharon Hiller.

This trial is a Phase 2a trial, which means that its effectiveness in a large group of participants has not yet been tested. Two such large Phase 3 trials will begin in the coming months to test whether monthly doses of oral islatravir can prevent HIV.

One study will be conducted on cisgender women in Africa and the United States, and the other will be conducted on men and transgender women who have sex with men.

Hillier explains that the long-acting nature of islatravir may have its benefits. “If you take it late or forget to take it, the drug may be more tolerant.

According to Warren, these preventative measures (pills, rings, injections) give people more options on how to protect themselves from HIV, but they are only worth it when they are actually taken.

And how to perform a Cabotegravir injection affects the likelihood that people will use it once it is registered for use in the country. To this end, Warren says there are two important lessons that can be learned from the deployment of oral PrEP.

First, when oral PrEP was first approved by US drug regulators in 2012, it took three years to arrive in South Africa. This time, Warren says the drug should be approved in many countries at once. “We need to move this around the world.

The second lesson is in collaboration.

The early days of oral PrEP were characterized by many small, isolated projects, he says. All cabotegravir rollout projects, benefiting from hindsight, Similar playbook..

Warren concludes: “What we don’t want is to attend this conference five years later and everyone present their individual projects, but we still don’t know how to deploy Cabotegraville.

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