An injectable drug to prevent HIV provides a substantial benefit, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF).
The new recommendations for pre-exposure prophylaxis, commonly known as PrEP, are consistent with what was issued by the USPSTF in 2019, with the only difference being the consideration of the injectable form of the drug cabotegravir — known commercially as Apretude.
The USPSTF gave the recommendation a grade A, meaning the group found with “high certainty that the net benefit is substantial” in prescribing Apretude.
The independent expert panel is formed by the Agency for Healthcare Research and Quality under the Department of Health and Human Services (HHS).
The Food and Drug Administration (FDA) approved Apretude in December 2021 for reducing the risk of sexually acquired HIV in adults and adolescents weighing at least 77 pounds. It is believed to be just as or possibly more effective as oral forms of PrEP like Descovy and Truvada.
In July 2022, the World Health Organization issued guidance recommending the PrEP injection as part of countries’ approaches to HIV prevention, finding that the drug is “safe and highly effective.” The organization said it hoped its recommendation would accelerate the utilization of the injection in other countries.
Unlike the older types of PrEP for HIV that are oral tablets taken daily, Apretude involves an injection that is administered once every other month following an initial schedule of two injections given one month apart. It is the first long-acting form of HIV PrEP to be made available in the U.S.
One study found that Apretude was more effective than Truvada in keeping people HIV-negative, which the FDA cited in its 2021 approval. Apretude is indicated for all people who are at risk of contracting HIV through sex regardless of biological sex, unlike Descovy which is not for people assigned female at birth.
“What’s so important about that is PrEP is most effective when taken as prescribed. So it’s adding an additional tool for healthcare professionals to make available to their patients who are at increased risk for HIV,” said John Wong, a member of the USPSTF and a primary care clinician in the Department of Medicine at Tufts Medical Center.
Oral forms of PrEP are considered extremely effective at preventing HIV infections when taken as prescribed. Missing one oral dose here or there shouldn’t have a major impact on the effectiveness of PrEP as long as the patient continues taking the medication, according to the Centers for Disease Control and Prevention.
Wong sees many patients who take PrEP and said some who struggle with remembering to take a daily pill or have trouble swallowing tablets, meaning an injection every 60 days or so may be a better option for them. He notes, however, that some patients have strong aversions to needles and would prefer the oral form of PrEP.
“I work with them to help set up reminder systems for them, whether they take the pill or whether they use injections because, again, PrEP is both safe and highly effective but it’s most effective when it’s taken as prescribed,” Wong said.
The active ingredient in Apretude, cabotegravir, is also sold in oral tablet form known commercially as Vocabria. This medication is used as a short-term treatment of HIV-1 in combination with the drug rilpivirine. This course of drugs precedes the long-acting treatment known as Cabenuva or may also be administered before starting a patient on Apretude.
