Long-acting HIV pre-exposure prophylaxis (PrEP) approaches: recent advances, emerging technologies, and development challenges

Agrahari, Vivek; Anderson, Sharon; Peet, M. Melissa; Wong, Andrew P.; Singh, O. N.; Doncel, Gustavo F.; Clark, Meredith R.

doi:10.1080/17425247.2022.2135699

Cited by 22 publications

(15 citation statements)

References 126 publications

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“…dapivirine vaginal ring, oral PrEP, condoms, and/or postexposure prophylaxis). Given that inability or unwillingness to use oral pills might drive preferences for CAB-LA, identifying suitable, effective prevention alternatives following CAB-LA discontinuation is key [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition

Fonner

Ridgeway

Straten³

et al. 2023

Aids

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Objective: HIV remains a significant burden, despite expanding HIV prevention tools. Long-acting injectable cabotegravir (CAB-LA) is a new preexposure prophylaxis (PrEP) product. We reviewed existing evidence to determine the efficacy and safety of CAB-LA as PrEP to inform global guidelines. Design: Systematic review and meta-analysis. Methods: We systematically reviewed electronic databases and conference abstracts for citations on CAB-LA from January 2010 to September 2021. Outcomes included HIV infection, adverse events, drug resistance, pregnancy-related adverse events, and sexual behavior. We calculated pooled effect estimates using random-effects meta-analysis and summarized other results narratively. Results: We identified 12 articles/abstracts representing four multisite randomized controlled trials. Study populations included cisgender men, cisgender women, and transgender women. The pooled relative risk of HIV acquisition comparing CAB-LA to oral PrEP within efficacy studies was 0.21 (95% confidence interval: 0.07–0.61), resulting in a 79% reduction in HIV risk. Rates of adverse events were similar across study groups. Of 19 HIV infections among those randomized to CAB-LA with results available, seven had integrase strand transfer inhibitor (INSTI) resistance. Data on pregnancy-related adverse events were sparse. No studies reported on sexual behavior. Conclusions: CAB-LA is highly efficacious for HIV prevention with few safety concerns. CAB-LA may lead to an increased risk of INSTI resistance among those who have acute HIV infection at initiation or become infected while taking CAB-LA. However, results are limited to controlled studies; more research is needed on real-world implementation. Additional data are needed on the safety of CAB-LA during pregnancy (for mothers and infants) and among populations not included in the trials.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition

Fonner

Ridgeway

Straten³

et al. 2023

Aids

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“…States, the timing of our data may suggest our results are most relevant for countries that which have not officially introduced or reimbursed PrEP yet -which is for example still the case in 23 out of 55 ECDC reporting countries (ECDC, 2023). However, novel formulations of PrEP with long-acting potential are becoming available at the moment (Agrahari et al, 2022) and similar framing issues may arise in countries that have made oral PrEP available already. Future research could examine the potential shift in current prevalence of different PrEP frames in relation to the chosen regimen.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Framing HIV pre-exposure prophylaxis use as a public or private matter

Martínez¹,

Jonas²

2023

Preprint

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PrEP campaigns often promote a medicalized ‘private’ frame that emphasizes personal HIV risk management. We explore how a ‘public’ frame emphasizing community maintenance of sexual health is increasingly relevant in men who have sex with men (MSM) and offers new intervention points for biomedical HIV prevention. In a cross-cultural examination of early adoption of PrEP frames, we sampled MSM from The United States (N=311 in 2015) and The Netherlands (N=222 in 2020) soon after each country’s official introduction of PrEP. Using linear regressions and machine learning, we calculated the prevalence of support for different PrEP frames, their person-level correlates, and their relevance for community-oriented actions like comfort disclosing one’s own PrEP use. The samples were mostly neutral about PrEP framing (US:44%, Netherlands:48%), yet many held a private (US:23%, Netherlands:28%) or public (US:33%, Netherlands:24%) PrEP frame. PrEP users in both countries were more likely to hold a public or neutral frame, non-users were more heterogeneous in their PrEP frames. Comfort with PrEP disclosure was more associated with a public than private frame. PrEP messaging and uptake could improve by understanding how MSM frame their PrEP use as a public or private matter and through context-informed interventions on views about PrEP disclosure.

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“…Although it's not yet as widely available as oral PrEP, it's a promising new option for individuals who might find it challenging to take oral PrEP daily. [21][22][23] PrEP is an essential component of combined HIV prevention and is highly effective in preventing virus acquisition when taken correctly as prescribed. Its use is crucial to achieving the Sustainable Development Goals (SDGs) and ending the AIDS epidemic by 2030.…”

Section: Introductionmentioning

confidence: 99%

“…Although it’s not yet as widely available as oral PrEP, it’s a promising new option for individuals who might find it challenging to take oral PrEP daily. 21–23…”

Section: Introductionmentioning

confidence: 99%

Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study

Sousa,

Nunes Ribeiro,

Santos

et al. 2023

Therapeutic Advances in Infection

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Background: Pre-exposure prophylaxis (PrEP) is a valuable tool in the response to the HIV epidemic, recommended for groups with a higher risk of HIV infection, such as men who have sex with men (MSM), particularly in the context of high-risk sexual behavior such as chemsex. Purpose: This study aimed to analyze the prevalence and factors associated with the intention to use PrEP among MSM who engage in chemsex in Brazil and Portugal. Methods: This was a cross-sectional study of a secondary dataset from a larger study conducted between January 2020 and May 2021 throughout Brazil and Portugal involving 1852 MSM who engage in chemsex. An initial descriptive analysis was performed to calculate the absolute and relative frequencies of independent variables related to the intention to use PrEP among MSM. A multivariate regression model was developed to identify factors independently associated with the intention to use PrEP. Results: Although a high level of PrEP knowledge (85.75%) was observed among MSM who engage in chemsex, the prevalence of intention to use PrEP was only 59.07%. Five variables were associated with a higher prevalence of intention to use PrEP [engaging in double penetration – adjusted prevalence ratio (aPR): 1.56, 95% CI: 1.44–1.69; being assigned female sex at birth – aPR: 1.34, 95% CI: 1.12–1.61; cruising – aPR: 1.21, 95% CI: 1.06–1.38; not using condoms – aPR: 1.20, 95% CI: 1.05–1.36; and being an immigrant – aPR: 1.16; 95% CI: 1.07–1.25], while having knowledge of postexposure prophylaxis (aPR: 0.91; 95% CI: 0.84–0.98), having a casual sexual partner (aPR: 0.86 and 0.85; 95% CI: 0.74–0.99 and 0.74–0.98), and engaging in group sex (aPR: 0.81; 95% CI: 0.73–0.90) were associated with a lower intention to use PrEP. Conclusion: The intention to use PrEP among MSM who engage in chemsex was high, and several factors were associated with this intention. Understanding the factors associated with the intention to use PrEP among MSM practicing chemsex is crucial for developing targeted interventions to increase PrEP uptake in this population. The results of this study suggest that tailored approaches are necessary to promote PrEP use in this population.

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Long-acting HIV pre-exposure prophylaxis (PrEP) approaches: recent advances, emerging technologies, and development challenges

Cited by 22 publications

References 126 publications

Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition

Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition

Framing HIV pre-exposure prophylaxis use as a public or private matter

Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study

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