Long-acting injectable PrEP could modestly decrease HIV incidence among MSM
Replacing daily oral PrEP with long-acting injectable PrEP could modestly decrease HIV incidence among men who have sex with men, according to a modeling study published in The Journal of Infectious Diseases.
“There is a lot of excitement about the various HIV prevention options in the research pipeline. Long-acting injectable (LAI) PrEP is likely to be the next innovation to become available to patients, so we wanted to model the potential impact on the HIV epidemic,” Kevin M. Maloney, MPH, epidemiology PhD student at the Rollins School of Public Health at Emory University, told Healio. “Long-acting PrEP seems to have performed well in clinical trials, but that doesn’t necessarily mean that it will do what we want for public health, once we start considering real-world implementation challenges.”
Maloney and colleagues used a dynamic network model of HIV transmission among men who have sex with men (MSM) to assess the population impact of LAI-PrEP compared with daily-oral PrEP.
The study demonstrated that if 50% of MSM chose LAI-PrEP, 4.3% (95% simulation interval, –7.3% to 14.5%) of infections would be averted over 10 years. Researchers added that the impact of LAI-PrEP would be slightly greater than a daily oral PrEP-only regimen based on “assumptions of higher adherence and partial protection after discontinuation.” According to the study, the highest population-level impact would occur after LAI-PrEP uptake and persistence improved.
According to Maloney, despite the modest reduction in infections, LAI-PrEP would be a great option for patients who struggle with daily adherence, although the increased number of clinical care visits may prove to be challenging for some.
“Our model did not target long-acting PrEP to the men who were designated to have low adherence to daily-oral PrEP,” he explained. “In the real world, there will be more nuanced decision-making, so we may see additional benefits if long-acting PrEP is used by patients who struggle with daily adherence to a pill.”
Maloney added that the cost of a LAI-PrEP is unknown but will likely cost at least as much as daily oral PrEP, “which is already too expensive.” With more clinical care visits required for LAI-PrEP, the financial burden would only increase, he said, but “it is possible that additional options will help drive down prices with competition.”
“Until a vaccine is available, PrEP is one of the best tools we have available for preventing new HIV infections,” Maloney concluded. “For almost a decade, we have struggled to increase uptake of PrEP. Alternative PrEP options could help increase uptake, but we shouldn’t just assume ‘if you build it they will come.’ We need to start building systems now that will make PrEP affordable and accessible to the individuals who need it the most.”