New Injectable PrEP Proven More Effective Than Truvada at Preventing HIV Infection

A new medication has emerged to protect men having sex with other men from contracting HIV.

It is called cabotegravir (CAB LA) and is injected every two months. A recent study says that CAB LA is 69% more effective than relying on people taking daily doses of Truvada to ensure pre-exposure prophylaxis (PrEP), which is a method to protect people who do not have HIV from acquiring it by having sex with an HIV positive person.

Truvada, manufactured by Gilead, contains two medicines (tenofovir and emtricitabine) that are also are used in combination with other medicines to treat HIV.

ViiV Healthcare, the company that has developed CAB LA, is being praised by AIDS Healthcare Foundation (AHF), whose president Michael Weinstein has been a critic of Truvada. In 2014 he sparked a sometimes angry debate over Truvada when he called it a “gay party drug.”

“CAB-LA’s formulation—and efficacy—resolve one of AHF’s earliest and sharpest criticisms of the prior PrEP protocol: its total reliance on patient adherence to a daily pill regimen for maximum preventive effect,” says a statement on the AHF website.

ViiV Healthcare announced results of an interim analysis of the success of CAB LA last week and said it would end the global study of its new HIV prevention medication early and offer all study participants access to CAB LA.

“We commend ViiV Healthcare for its tremendous breakthrough with cabotegravir and thank the company for suspending its study to make CAB LA readily available to all study participants,” said Michael Wohlfeiler, MD, chief of medicine, US for AHF. “As an injectable, two-month dosed medication that’s demonstrated significantly greater efficacy than the current form of pre-exposure prophylaxis, cabotegravir offers an exciting way forward to far simpler and more effective HIV prevention.”

ViiV’s study cohort included 4,600 men who have sex with men (MSM) and transgender women who have sex with men in studies from over 40 sites around the globe. The study compared cabotegravir (CAB LA) injections administered every two-months to the current standard of care, daily oral emtricitabine/tenofovir disoproxil fumarate 200 mg and 300 mg (FTC/TDF) tablets, the HIV/AIDS treatment medication branded as Truvada.

“From the very beginning of this debate, AHF voiced significant concerns about PrEP’s reliance on patient adherence to a daily pill regimen to achieve its preventive benefit,” said Michael Weinstein. “ViiV’s remarkable study results here validate many of our earlier criticisms and concerns about PrEP. Cabotegravir looks to be an exciting new addition to the world of HIV prevention.”

Since the federal Food and Drug Administration approved Gilead’s application to market its AIDS treatment medication Truvada for use as PrEP on July 16, 2012, AHF has repeatedly expressed concerns about the prevention protocol, particularly its reliance on patients’ adherence to daily pill dosing.

In an article published in 2017 in AIDS, the journal of the International AIDS Society, Weinstein and other AHF executive “…voiced concerns that PrEP would be difficult to implement because of healthcare barriers, have limited efficacy because of poor adherence, and increase risky sexual behaviors and transmission of other sexually transmitted infections.

The article also pointed out that the characterization that AHF was “ardently anti-PrEP” was an “inaccurate oversimplification” of AHF’s position as AHF recognized, “There is no doubt that PrEP is highly effective when taken correctly.”