With technological advancements, many recent changes have happened to HIV PrEP medications. These changes may significantly lower the risk of HIV with fewer doses. Learn about the latest updates on HIV PrEP effectiveness and side effects in this article. Log on to www.doralhw.org for a consultation.
HIV PrEP drugs
There are mainly two PrEP drugs approved for daily use. The drugs are given in combinations with two anti-HIV drugs in a single pill:
- Truvada® (emtricitabine/tenofovir disoproxil fumarate): This is for all people at risk for HIV through sex or injection drug use. You can also get them in generic versions.
- Descovy® (emtricitabine/tenofovir alafenamide): This is for sexually active men and transgender women who are at risk of getting HIV. It’s not designed for females who are at risk for HIV through receptive vaginal sex.
Latest updates on PrEP drugs
Two PrEP drugs – cabotegravir and lenacapavir have recently been approved for use.
- Lenacapavir:
Lenacapavir (brand name: Sunlenca) is a prescription drug that was approved by the U.S. Food and Drug Administration (FDA) to treat HIV infection in adults whose condition doesn’t improve with other HIV medicines and who meet certain requirements to take this medicine. This medicine is always given in combination with other HIV medicines. Lenacapavir is the first long-acting drug that is administered just once every 6 months. This drug can disrupt the protein shells (capsids) of HIV that are essential to replication, which stops the process of multiplying in the body.
A new study on lenacapavir has found that it’s 100% effective in preventing HIV in females. In this study, more than 5000 females in Uganda and South Africa took part in the research, 2,134 of them got injections, and none of them were reported to have HIV. Whereas the other sections of the study that involve oral prevention pills – descovy and Truvada – daily, found 2% of them reported HIV infections. While the results of testing in men haven’t been calculated yet, experts believe that this drug may have the potential to lower the number of new HIV infections significantly if this drug becomes widely accessible.
- Cabotegravir:
Cabotegravir (brand name: Apretude) is another long-acting drug that is given by injection once every 2 months. Healthcare professionals also call this drug long-acting cabotegravir or CAB-LA. This drug is also used for people living with HIV as part of their treatment in combination with another injected medication. It works by blocking the active site of HIV integrase, which prevents its strand transfer to the viral genome into the host genome, which prevents the replication of the virus.
The HIV Prevention Trials Network conducted a study on the safety and efficacy of the long-acting injectable drug cabotegravir for PrEP in HIV-uninfected women. This trial was stopped early by the Data and Safety Monitoring Board (DSMB) because the results showed that this drug is highly effective in preventing HIV.
For this study, 3,223 women between the ages 18 to 45 years old who were at risk of getting HIV infection from 20 different sites across seven countries in sub-Saharan Africa (Botswana, Kenya, Malawi, South Africa, Eswatini, Uganda, and Zimbabwe participated. The study participants were divided into two groups. One with the drug cabotegravir and daily oral PrEP placebo, and the other one with daily oral PrEP drugs and cabotegravir placebo for every 8 weeks (about 2 months).
The result shows that 38 women acquired HIV, of which 4 take long acting cabotegravir and 34 take daily oral PrEP. This shows an HIV incidence rate of 0.21% in the cabotegravir group and 1.79% in the oral PrEP group. This shows while both methods are highly effective in preventing HIV, long acting cabotegravir was 89% more effective than oral PrEP.
Both cabotegravir and oral PrEP are well tolerated and work well in mild to moderate severity.
Effectiveness
- Cabotegravir:
In studies, it is found that injectable cabotegravir used as PrEP is more effective than oral PrEP which includes – tenofovir disoproxil and emtricitabine because it is easy to miss oral doses daily but not with injectable cabotegravir. In a large study of gay and bisexual men and transgender women, injectable cabotegravir PrEP lowers the risk of getting HIV by 66% compared to oral PrEP.
Similarly, in another large study on cisgender women, injectable cabotegravir PrEP lowered the risk of getting HIV by 88% compared to oral PrEP. The risk of reduction might be higher in women because the missing doses of oral PrEP may have a massive impact on how well PrEP works in women than in men.
- Lenacapavir:
Lenacapavir was found to be highly effective in different studies. In the study of cisgender women and gender-diverse people, no one acquired HIV after receiving 2 doses of lenacapavir injections. This shows a 100% reduction in HIV infections compared to HIV incidence. It shows more effectiveness than oral HIV PrEP Truvada and Descovy. This means it provides complete protection against infection with minimum clinical target exposure.
Side effects
- Lenacapavir:
Like every drug, it may cause side effects such as nausea, occasional dizziness, etc. which are manageable. Other possible side effects are common injection site reactions like swelling, redness, pain or discomfort, itching, hardened skin, or a small mass or lump. If you develop hardened skin or a lump, it may take longer than other reactions to go away or it may not heal on its own. If the injection site reaction is severe or doesn’t get better within a few days or gets worse, you should contact your healthcare provider. You should tell your healthcare provider if you have any side effects that bother you or don’t go away on their own.
- Cabotegravir:
Cabotegravir side effects happen occasionally affecting at least 1 out of 10 people, including:
- Injection site reactions (pain, tenderness, or lumps at the injection site)
- Diarrhea
- Headache
- Raised liver enzymes
- Feeling hot or feverish.
Many people get used to injection site reactions after a few injections. For the first 2 or 3 injections, you can take over-the-counter pain medication within a couple of hours of the injection and continue as needed for some days. You can also use a warm compress or heating pad at the injection site for 15 to 20 minutes.
Other common side effects that are rare, include:
- Difficulty sleeping, abnormal dreams, depression, anxiety, dizziness.
- Rash
- Muscle ache
- Tiredness or weakness
Some uncommon but serious side effects include:
- Suicidal thoughts or behaviors (only people with a pre-existing psychiatric illness may likely experience).
- Hypersensitivity or allergic reaction
- Liver inflammation
If you have any side effects that don’t go away or get worse, you should talk with your healthcare provider.
The latest HIV PrEP drugs are amazingly effective with fewer side effects. They show very promising results in preventing HIV. Once they are widely accessible, the prevalence of HIV will decrease.
Need help with HIV prevention, visit our infectious disease specialist in Brooklyn clinic to get professional medical help. Call us to book your appointment now and protect yourself from this deadly infection!!!!
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