- During 2021, 4,000 new HIV infections were registered every day.
- Despite all the advances, a vaccine against this disease has not yet been developed.
- Now a new long-acting intramuscular injectable drug has shown good results for HIV prevention.
Although the world is constantly concerned about the appearance of new diseases, there are also other old ones that have not yet been controlled. Within this second category is the HIV, which is already a public health problem, but now a new medical indication for its prevention has been revealed.
Although the origin of this disease is unknown, it was not until 1983 when the term HIV was coined for its identification. The biggest problem is that there is still no cure or solution for the disease, although at the beginning of 2021 the first vaccine in history to advance to phase 3 clinical trials.
Despite the above, through scientific advances, the development of antiretrovirals that allow patients better control of their disease. The goal is to prevent it from becoming AIDS, considered the most dangerous stage and in which practically all people are sentenced to death.
Update on medical indications
Now, the most novel thing is that today the World Health Organization (WHO) published new guidelines for HIV prevention. The biggest change is that it recommends the use of cabotegravir long-acting injectable (CAB-LA) as pre-exposure prophylaxis (PrEP).
Based on the above, he asked the countries to consider this option of safe and highly effective prevention for people at substantial risk of HIV infection.
The guidelines, published before the 24th International AIDS Conference (AIDS 2022), will help countries plan for the introduction of CAB-LA as part of a comprehensive approach to HIV prevention and facilitate urgently needed operational research.
🆕 WHO guidelines encouraging countries to deliver long-acting injectable cabotegravir (CAB-LA) – a key to preventing #HIV infection among people at substantial risk.
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— World Health Organization (WHO) (@WHO) July 28, 2022
The guidelines are released at a critical time because HIV prevention efforts have stalled with 1.5 million new infections in 2021. Thus, there were 4,000 new infections each day of the year, with key populations (sex workers, men who have sex with men, people who inject drugs, people in prison, and transgender people) and their sexual partners, accounting for 70%. of infections worldwide.
“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but it is not yet available outside study settings. We hope that these new guidelines will help accelerate countries’ efforts to begin planning for and offering CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring,” said Dr. Meg Doherty, Director of the WHO Global Programs on HIV, Hepatitis and Sexually Transmitted Infections.
What is this new drug?
CAB-LA is a long-acting intramuscular injectable form of PrEP. With the first 2 injections given 4 weeks apart, followed by one injection every 8 weeks, it was shown to be safe and highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in 2 randomized controlled trials , HPTN 083 and HPTN 084.
Together, these landmark studies found that CAB-LA use resulted in a 79% relative reduction in HIV risk compared to oral PrEPwhere adherence to daily oral medication intake was often a challenge.
Long-acting injectable products have also been found to be acceptable and sometimes preferred in studies examining community PrEP preferences.
WHO will continue to support evidence-based strategies to increase access to and uptake of PrEP, including through adoption of CAB-LA. Key actions include:
- WHO will support countries and partners to safely and effectively include CAB-LA in HIV prevention programmes.
- WHO is working with Unitaid and other partners to develop implementation science projects to respond to outstanding safety issues, implementation challenges, and understand people’s preferences for CAB-LA, among other HIV prevention options.
- WHO is working with countries, communities and donors, including the Global Fund, PEPFAR and the Bill & Melinda Gates Foundation, to support the inclusion of CAB-LA in their programs and to catalyze implementation science and program monitoring to that CAB-LA can be implemented, safely and effectively, to achieve the greatest impact.
- The WHO Global PrEP Network will host webinars this year on CAB-LA to provide up-to-date information to countries, communities and implementers and raise awareness.
- In April 2022, CAB-LA was added to the WHO Expressions of Interest list for prequalification evaluation, and WHO is working with countries on regulatory approval.
- Both oral PrEP and CAB-LA are very effective. WHO will continue to support prevention options. CAB-LA increases the options available and should always be offered alongside oral PrEP. Some people may continue to choose oral PrEP, and people who find it difficult or don’t want to take tablets may prefer CAB-LA.
- WHO has also released new differentiated and simplified PrEP guidance at the AIDS 2022 conference to support easier access, including community delivery.