In 2021, HIV continues to be a illness with large nationwide and worldwide affect. There are over 1.2 million individuals within the US estimated to be dwelling with HIV as we speak, and roughly 1.7 million new infections occurred globally final 12 months.
In components of the US, HIV charges are at the moment climbing amongst underserved populations. We’ve seen a latest epidemic amongst individuals with out secure housing in Boston, and related outbreaks in areas like West Virginia and Philadelphia. The COVID-19 pandemic has solely exacerbated the issue as a result of many individuals have had much less entry to testing and medical look after HIV. Now greater than ever, medicines often known as pre-exposure prophylaxis — or PrEP — might assist reverse this worrisome development by stopping individuals from getting HIV. And new formulations might make it straightforward for a wider vary of individuals in danger for HIV to make use of PrEP. Already, one is being reviewed by the FDA.
What’s PrEP, and is it an possibility for me?
PrEP is a mix of medicines that considerably lowers the chance of getting HIV. It may be prescribed by major care docs or infectious illness specialists. Often, it’s coupled with screening for different sexually transmitted infections and common HIV testing. The Facilities for Illness Management and Prevention (CDC) recommends PrEP for these at excessive threat for getting HIV, together with males who’ve intercourse with males, heterosexual women and men with high-risk exposures, transgender girls, and individuals who inject medicine.
What varieties of each day PrEP can be found?
At the moment, there are two FDA-approved formulations of PrEP. Each are prescribed as a each day capsule.
- The primary, which has been permitted since 2012, is Truvada (emtricitabine/tenofovir disoproxil fumarate). It’s permitted for all the chance teams talked about above.
- A more recent formulation of PrEP referred to as Descovy (emtricitabine/tenofovir alafenamide) was permitted in August 2019. It’s permitted just for individuals who interact in anal intercourse (not vaginal intercourse), as a result of cisgender girls weren’t included in research to indicate effectiveness.
To learn extra about these two choices, see this weblog put up.
What about long-acting PrEP?
New, long-acting, injectable formulations are additionally actively being examined in scientific trials, with very promising outcomes below FDA evaluation. Considered one of these (cabotegravir, or CAB LA) is given as a shot each two months. Two latest trials (see right here and right here) present long-acting cabotegravir to be very secure and efficient in stopping individuals from getting HIV. Much more encouraging, these research enrolled a wider group of individuals than earlier research of PrEP had executed. One research centered particularly on cisgender girls confirmed wonderful outcomes. The opposite enrolled greater than 500 transgender girls, and greater than half the US individuals recognized as Black. In contrast, many earlier trials of different PrEP medicines concerned largely white individuals, and sometimes had very restricted numbers of transgender girls.
One other promising new possibility for PrEP is the dapivirine vaginal ring. This was not too long ago advisable by the WHO as a selection for ladies at excessive threat of buying HIV. Two research, the RING research and the ASPIRE research, demonstrated a big threat discount of buying HIV amongst those that used the ring versus placebo, though there have been some challenges with adherence. This treatment is already permitted in Europe; within the US, it’s at the moment present process FDA evaluation.
We hope that FDA approval of long-acting medicines like injectable cabotegravir will supply extra choices for individuals who could battle with or not need to take a each day treatment. Elevated flexibility and long-acting choices are essential to extend general use of PrEP.
The underside line
The good thing about PrEP is evident: it’s greater than 90% efficient at lowering the chance of getting HIV. Together with routine STI screening, PrEP is a vital a part of staying wholesome for anybody who could also be at excessive threat for getting HIV.
Nonetheless, prescriptions for PrEP are solely reaching a small quantity of people that may gain advantage from drugs to stop HIV, notably amongst feminine, Black, and Latinx populations. Better consciousness and entry might assist flip the tide and forestall outbreaks of sicknesses throughout the US. The brand new long-acting formulations for many who would possibly battle with or want to not take a each day capsule will assist.
We should push for elevated entry to those lifesaving medicines, and for FDA approval to permit for the usage of these new medicines within the US. Whereas doing so, it’s important to make entry to PrEP equitable for everybody who’s in danger for HIV in our communities.
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