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Expanding range of options to prevent HIV is key as no one size fits all

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Shobha Shukla - CNS

Increasing the range of options for people to choose from to break the chain of HIV transmission is important if we are to end AIDS by 2030
Increasing the range of options for people to choose from to break the chain of HIV transmission is important if we are to end AIDS by 2030
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While the currently available HIV prevention and treatment tools have helped reduce new HIV infections and AIDS-related deaths by 23% and 39% respectively since 2010, we still have a long way to go before ending this epidemic. With 1.7 million new HIV infections and 690,000 AIDS-related deaths in 2019, one cannot but over emphasise the urgent need to have more HIV prevention options, including long-acting HIV prevention strategies that might prove to be more acceptable and user friendly to people from diverse communities.

Topping the list is the much-awaited long-acting dapivirine vaginal ring that has finally seen the light of the day and is under regulatory approval processes of several countries. This long acting female oriented HIV prevention option is designed to be used by women discreetly. It is a silicon ring impregnated with dapivirine which a woman can insert in her vagina and be protected from acquiring HIV for 28 days at a time. The ring has to be replaced once every month.

Other promising products in advanced stages of development were also announced at the ongoing 4th HIV Research for Prevention global conference (#HIVR4P Virtual). These include long-acting injectable pre-exposure prophylaxis (PrEP) for women and Islatravir as a once-monthly PrEP pill, as well as a promising new method to induce broadly neutralising antibodies (bNAbs) that could help speed HIV vaccine development.

"COVID-19 has disrupted research around the world, so it is especially exciting to see this new progress. These research advances could help significantly strengthen our HIV prevention toolkit", said Professor Adeeba Kamarulzaman, President of International AIDS Society (IAS); Dean of the Faculty of Medicine, University of Malaya; and Adjunct Associate Professor at Yale University.

long-acting injectable

HPTN-083 studies had reported last year that long-acting injectable cabotegravir (CAB) - a new integrase inhibitor - was superior to daily oral TDF/FTC (tenofovir / emtricitabine) in preventing HIV among cis-gender men and transgender women who have sex with men. Now, the HPTN-084 study has revealed that it is also safe and effective in preventing HIV infection in cis-gender women.

Interim results, presented by Professor Sinead Delany-Moretlwe of the University of the Witwatersrand, from HPTN-084 (a phase-3 randomized, double-blinded superiority trial evaluating safety and efficacy of long-acting once-every-8-weeks injectable CAB compared to daily oral TDF/FTC for HIV prevention in cisgender women), show that while both products demonstrated high prevention efficacy and were safe and well tolerated, CAB was superior to TDF/FTC in preventing HIV infection in cis-gender women in Africa. Women in the CAB group had an 89% lower risk of HIV infection compared to the TDF/FTC group, likely because of the adherence advantage conferred by the once every 8 weeks (2 months) injections.

Islatravir, the once a month pill

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