On the eve of the 24th International Aids conference, the World Health Organisation (WHO) urged countries to use long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV. WHO said CAB-LA is a safe and highly effective prevention option for people at substantial risk of HIV infection.

WHO announced new guidelines for using CAB-LA as PrEP for HIV on Thursday. The policies will support countries planning for CAB-LA introduction and facilitate urgently needed operational research.

CAB-LA is an intramuscular injectable, long-acting form of PrEP. The first two injections are administered four weeks apart, followed by an injection every eight weeks.

Two randomised studies, HPTN 083 and HPTN 084 found CAB-LA safe and highly effective. This is especially among cisgender women, and cisgender men who have sex with men. It is also effective for transgender women, who have sex with men.

CAB-LA highly effective and safe to use

The studies found that using CAB-LA resulted in a 79% reduction in HIV risk compared with oral PrEP. At the same time, studies examining community PrEP preferences found long-acting injectables were the most accepted and preferred.

WHO Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, director Dr Meg Doherty stated that the new guidelines would help to accelerate countries’ efforts to make CAB-LA available.

“We hope these new guidelines will help to accelerate country efforts to start to plan and deliver CAB-LA. This is alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring,” said Doherty.

Alarming rate of new HIV infections

According to WHO, the guidelines come at a  critical moment, as HIV prevention has stalled. Almost one and half million new HIV infections recorded in 2021 and 2020. Four thousand new infections were recorded daily in 202.  Key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and transgender people) and their partners account for 70% of HIV infections globally.

The new CAB-LA guidelines are based on a public health approach that considers effectiveness, acceptability, feasibility, and resource needs across various settings. The guidelines will facilitate CAB-LA delivery, and operational research is urgently required to address implementation and safety issues. They will also inform decisions on how to successfully provide and scale up CAB-LA as the guidelines also highlight critical research gaps, including matters relating to HIV.

CAB-LA can transform HIV prevention

Tenu Avafia, the deputy executive director of Unitaid, said the new injectable cabotegravir could transform HIV prevention. But he warned that countries need to roll out CAB-LA faster.

“New HIV prevention options now reaching the market, such as injectable cabotegravir, hold the promise to transform HIV prevention. But we must move far more quickly than we did with oral PrEP to have a real impact on the epidemic. This new coalition will prioritise the acceleration of affordable, equitable and widespread access to injectable long-acting cabotegravir for PrEP without delay,” said Avafia.

The president of the International Aids Society, Adeeba Kamarulzaman, also said the new long-acting PrEP could play a significant role in ending the HIV pandemic.

“Long-acting PrEP could significantly end the HIV pandemic, but very few people can get it right now. Scaling up affordable access to this game-changing prevention tool must be a top global priority, “said Kamarulzaman.-Health-e News.