Long-acting injectables for the prevention or treatment of HIV

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In recent years, long acting injectables (LAIs) have been introduced into clinical practice for the treatment and prevention of HIV infection. These agents present another option for patients who may struggle with adherence to a daily oral medication, have difficulties swallowing oral medications, and those who generally prefer a long-acting agent. There are currently two LAIs approved for the treatment of HIV: cabotegravir co-packaged with rilpivirine (CAB/RPV) and lenacapavir (LEN). CAB/RPV was FDA approved in 2021 and is a complete regimen for the treatment of HIV-1 infection. It is administered as two gluteal intramuscular injections either every four or eight weeks. Lenacapavir is a first-in-class capsid inhibitor and was FDA approved in 2022 for use in heavily-treatment experienced adults with multidrug resistant HIV-1 infection in combination with other antiretrovirals. Lenacapavir is administered as two subcutaneous injections into the abdomen every 6 months, and at initiation patients must also take oral tablets based on 1 of 2 dosing strategies.

There is currently one LAI approved for HIV pre-exposure prophylaxis (PrEP). Cabotegravir (CAB) was FDA approved in 2021 and is administered as a gluteal intramuscular injection every 8 weeks. In addition to those LAIs currently approved for the treatment and prevention of HIV, there are several long-acting agents currently under investigation, including new dosing strategies for currently available agents, weekly oral regimens, and monoclonal antibodies. Notably, results were recently published regarding the use of subcutaneous LEN given every six months for PrEP.

The information regarding trials supporting the use of LAIs for the treatment and prevention of HIV is compiled here.

 

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