PrEP Without Pills
There’s a new PrEP medicine available, and it’s not a pill you must take every day! Cabotegravir (brand name Apretude, also known as CAB) is given as an injection every other month. For people who have trouble taking daily pills, this may be a helpful option since we know PrEP (pre-exposure prophylaxis) works best when it’s taken consistently.1,2
Does the injection work?
Short answer: Yes. Studies found that injectable Cabotegravir was more effective than Truvada at preventing HIV. It also had the same amount of side effects. Scientists performed a randomized-controlled trial with more than 4,500 people around the world, all cisgender men and transgender women who have sex with men. Half used CAB, and half took Truvada pills. The people in the study were tested for HIV regularly for an average of about a year and a half (ranging from 6 months to 2 years).3
Thirteen people tested positive for HIV out of 2,243 people who took CAB, compared to 39 in the Truvada group. This means the people using CAB had about one-third the chance of infection compared to people using Truvada. And in the CAB group, only 4 of those 13 became positive while actively taking CAB. The others were positive before they started or in the first couple of weeks, or they had stopped taking the drug for some months.
So, CAB works well to prevent infection. Great news! (This is not to say that Truvada doesn’t work – it does! It works best when taken consistently every day. It’s just harder to take a pill every day than to get a shot every two months.)
A similar trial in cisgender women is scheduled to wrap up in May 2022, so we should have information about how effective CAB is for that group soon.4
What are the side effects?
CAB caused side effects about as often as Truvada did. About 5 percent of people taking either drug had a serious side effect. For both, around 2 percent of people had a liver problem serious enough to cause them to stop taking the drug. This is one important reason to get blood tests done every few months while using PrEP.5
Both drugs may cause a small amount of weight gain, in the range of 2-3 pounds per year. When first starting CAB, some redness or pain at the injection site was common. This was usually mild, and it became less of a problem over time for most people. Only 2-3 percent of people stopped using CAB because of skin irritation.5
Another concern is drug resistance. For people who become infected with HIV while taking PrEP, the HIV strain they carry could become resistant to ART (antiretroviral therapy). With Truvada, this is rare and is most likely to happen if a person starts taking the drug when they have recently been infected with HIV. (This is why it’s so important to check HIV status before starting PrEP). In lab tests, HIV did not easily develop resistance to CAB. Ongoing studies will give us more information about resistance.5-7
Access to treatment
PrEP can prevent HIV infection for so many people, helping to get us closer to a goal of no new HIV infections. But will the people who want it be able to get it? Brand-name PrEP options are expensive and can be out of reach for people who don’t have insurance.8
There are programs for uninsured people to get PrEP for free, but they tend not to pay for the recommended blood tests. A generic version of Truvada is now available, so that is more affordable. In 2021, the United States government started requiring private insurance companies to cover PrEP pills and the necessary blood tests without a co-pay.8,9
Long story short: CAB will likely be expensive at first and probably will be easier to access for people with health insurance.8
A person using CAB will need to go into a clinic to get the injection every other month.
PrEP is a key tool for preventing HIV. We know that only about a quarter of people who could benefit from PrEP are using it, so new options that can make it easier to use are welcome. Cabotegravir is a new and effective option that may get PrEP to more people – another step toward ending HIV.10
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