WHO Endorses Injectable PrEP for HIV Prevention
By Winniecynthia Awuor
With the weakening progress in the fight against HIV/AIDS, the World Health Organization (WHO) has urged countries to use long-acting injectable cabotegravir (CAB-LA) as an additional pre-exposure prophylaxis (PrEP) option basing on its effectiveness in HIV prevention.
CAB-LA is an intramuscular injectable, a long-acting form of PrEP, with the first two injections administered 4 weeks apart, followed by an injection every 8 weeks.
“Long-lasting CAB-LA is a safe and highly effective HIV prevention tool but is not yet available outside study settings,” said Dr. Meg Doherty, Director of who’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes in a statement.
“We hope these new guidelines will help the countries accelerate efforts to start planning and delivering CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.”
The launch of these guidelines comes at a critical moment as the HIV prevention effort has stalled with 1.5million new infections in 2021 as key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and transgender people) account for 70% of HIV infections globally.
It was shown to be highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in two randomized trials, HPTN 083 and HPTN 084.
Both the studies found the use of CAB-LA resulted in a 79% relative reduction in HIV risks compared to oral PrEP, where adherence to daily oral medication was found to be a challenge.
Additionally, the guideline showed that both PrEP and CAB-LA are highly effective but CAB-LA should always be offered alongside oral PrEP.
The guidelines also note that HIV testing is crucial before admission of CAB-LA and should be conducted before each injection while in use and after discontinuation.
“PrEP should only be administered to HIV-negative persons,” the guidelines caution, adding that those with reactive test results before CAB-LA initiation or during use, need further testing to confirm their diagnosis.
If the test result confirms that they are HIV positive, an individual should be well informed, supported, and linked to antiretroviral treatment (ART), the guidelines add.
Additionally, medical practitioners are required to conduct liver function testing (measuring alanine transaminase) before and during use of CAB-LA as the guidelines caution the drug should not be initiated in persons with advanced liver disease or acute viral hepatitis.
Further assessment for those with reactive test results for Hepatitis B (HBV) and Hepatitis C (HCV) are strongly encouraged as CAB-LA may be inappropriate for those requiring treatment for Hepatitis B.
“For people eligible for HBV treatment as per WHO guidance, oral PrEP should be offered as the preferred PrEP option as it will both suppress HBV and prevent HIV. Alternative PrEP and HIV prevention options should be considered as no kidney toxicity is anticipated during the use of CAB-LA,” the guidelines state.
In accordance with the previous WHO guidelines, the new CAB-LA guidelines are based on a public health approach that considers effectiveness, acceptability, feasibility, and resource needs across a variety of settings.
The launch of the new guidelines also marked the launch of a new coalition to accelerate global access to CAB-LA. This was convened by WHO, Unitaid, UNAIDS, and the Global Fund to identify market interventions needed to advance near-and long-term access to CAB-LA, establish financing and procurement for the drug, provide implementation support to global HIV prevention programs, and issue policy guidance.