Long-Acting Injectable Antiretroviral Could "Help End AIDS"

To unleash the game-changing potential of long-acting and extended-delivery antiretroviral medication in the fight against the HIV epidemic in high-prevalence countries, a coordinated rollout involving governments, large funders, and manufacturers is crucial, advises a commentary piece published in the Journal of the International AIDS Society.

“The proven effectiveness of injectable cabotegravir (CAB-LA) is higher than that of any other HIV prevention intervention ever trialed or implemented, surpassing medical male circumcision, condoms, and combination antiretroviral treatment,” wrote corresponding author Gesine Meyer-Rath, MD, PhD, of the Health Economics and Epidemiology Research Office, Johannesburg, South Africa, and members of the South African Department of Health’s preexposure prophylaxis technical working group.

The commentary specifically focuses on factors the authors believe will be necessary to ensure an adequate supply and demand of CAB-LA and, ultimately, other long-acting and extended-delivery antiretroviral drugs. 

Affordability for low- and middle-income countries is essential, the authors point out. This will require creating markets of a guaranteed size and the involvement of PEPFAR (the United States President’s Emergency Plan for AIDS Relief), the Global Fund, the Bill & Melinda Gates Foundation, or other large funders. Rapid regulatory approval, integration of CAB-LA into national guidelines, and manufacturing capacity will also be essential. Creating programs that offer CAB-LA at the community and private health care level could help fuel demand.

A successful rollout will require large-scale organization and effort, but the commentary authors believe CAB-LA could be the game changer long hoped for in the battle against HIV.

“For now, CAB-LA, together with maintaining high uptake of HIV testing and treatment, has the singular potential to help end AIDS,” they wrote. “We collectively have a single shot to show that we dare not waste this potential.”

Reference: 
Meyer-Rath G, Jamieson L, Pillay Y. What will it take for an injectable ARV to change the face of the HIV epidemic in high-prevalence countries? Considerations regarding drug costs and operations. J Int AIDS. Soc. 2023;26 Suppl 2(Suppl 2):e26106. doi:10.1002/jia2.26106