At the 25th International AIDS Conference (IAS) in Munich, Germany, last summer, expectations were high for injectable antiretroviral treatments used to prevent HIV transmission. The results of studies on the effectiveness of Lenacapavir (Sunleca) in the context of HIV pre-exposure prophylaxis (PrEP) were presented. Lenacapavir being an injectable drug administered twice a year, effective against resistant viruses in HIV+ people who have failed previous treatments. We were also awaiting the results of the data on cabotegravir (Apretude) administered every 2 months in the same context of PrEP, in cis-gender women, for whom traditional PrEP had not demonstrated good effectiveness. These 2 long-acting injectable medications were compared to Truvada (traditional Prep) currently used as standard treatment in tablets taken continuously every day, or on demand for pre-exposure prophylaxis.
Led by Dr. Linda-Gail Bekker, director of the Desmond Tutu HIV Foundation at the University of Cape Town and former president of the International AIDS Society, the study presented in Munich on Lenacapavir opens up new perspectives. Lenacapavir demonstrated 100% effectiveness in cis-gender women and girls at risk of infection, “The results presented were received very positively. We even got a standing ovation at the end of the presentation. I haven’t seen this often. I haven’t seen that since I started practicing,” rejoices Dr. Pierre Côté, doctor at the Quartier Latin Urban Medicine Clinic.
Note that Cabenuva (combining cabotegravir and ripivirine) is currently prescribed and reimbursed by drug insurance (private and public).
“Long-acting injectable treatments will certainly be used more and more in the future, whether to treat or prevent HIV,” explains Dr. Pierre Côté. The majority of patients who have used injectable treatment are very satisfied and tolerate it very well. They generally fear less stigma since they are not pills to be taken daily. They thus avoid having to answer to justify why they take these medications on a daily basis.
In PrEP, an injection every two months (of cabotegravir, marketed under the name Apretude) or twice a year (of lenacapavir, which will be marketed under the name Sunlenca) is more practical than PrEP taken daily. This reduces the number of pills they have to take and the person has less to worry or fear about missing doses. This better adherence to long-acting injectables explains the superiority of lenacapavir and cabotegravir in the clinical studies presented.
We haven’t heard the last thing about long-acting medications. New formulations of medications taken orally are being studied and could see the light of day: taken once a week, per month, every 2, 4 or 6 months or even perhaps once a year!
Studies are also underway to demonstrate the effectiveness of drugs such as lenacapavir and cabotegravir in various more vulnerable populations such as injecting drug users for whom long-acting treatments would be the most beneficial because they would address the cause. main failure with this clientele. These more vulnerable populations more often have difficulty adhering to PrEP as it is currently used on a daily basis. We can ask ourselves the question of who will really benefit from injectable PrEP and when (as they are not yet covered by the public drug insurance plan and many private insurers)? “The cost of an Apretude injection is around $1000 per injection (or a little over $6000/year). Although the cost is not yet known, I would bet on comparable annual costs for two Sunleca injections per year, continues Dr. Pierre Côté. [ndlr : à l’heure actuelle, on palre de 40 000$/an pour le traitement de Sunlenca aux États-Unis].
Not sure that the RAMQ drug plan will reimburse it anytime soon if the costs remain so high. “Initially, only people with good private insurance will be able to have access to them… The government and people in the industry will certainly have to negotiate and make compromises to provide access to these treatments which will help everyone, including the most vulnerable people. vulnerable and those most at risk.”
“I have another concern: since the use of PrEP, we are seeing an increasing increase in STBBIs (infections transmitted by sex and blood): gonorrhea, chlamydia, syphilis, among others. Currently, we see patients on PrEP for follow-up approximately every 3 months. This makes it possible to detect STBBIs early and treat them quickly to prevent people from becoming more infected without knowing it because they do not show symptoms. If visits are only made twice a year, is there a risk of a possible resurgence of these STBBIs?”, asks Dr Pierre Côté. “We will certainly have to adapt. In short, these are not vaccines or cures, but these injectable treatments represent a significant scientific advance for patients and for prevention.
