- IrsiCaixa AIDS Research Institute. Barcelona
- BCN Checkpoint: Barcelona
Oral Pre-exposure prophylaxis (PrEP) has shown high efficacy for preventing HIV infections among at risk people, but despite that, access to PrEP is still limited. Key populations which could benefit from it, not always can have access due to several barriers. The first is lack of provision through local health services. To be noticed that PrEP is not yet included in many National Health Services across the world. But other barriers can limit the access to PrEP, such as lack of information among candidates to PrEP, reluctance among health providers, cost, stigma toward PrEP users, etc.
Thus, first of all, the future of PrEP must go hand in hand with the guarantee that all people who could benefit have access to it.
Availability of other formulations and ways of delivering PrEP can also facilitate its uptake. Several research lines are ongoing. Recently have been published the results of the largest PrEP clinical trial up to date: the DISCOVER study, which has shown the efficacy of the combination of two antiretroviral drugs (Tenofovir alafenamide and Emtricitabine). So far, only Tenofovir disoproxil fumarate (usually combined with Emtricitabine) had showed efficacy for oral PrEP. The main advantage of the new formulation is its safer profile for kidney and bone, and consequently allowing more people taking PrEP, especially those with risk for renal failure or osteoporosis.
Other ways of PrEP delivering have been studied or are currently on development. Two studies implemented in women have shown certain efficacy of vaginal rings with Dapivirine.
Also recently have been presented the results of the study HPTN 083, showing even a higher efficacy of a long acting injectable of Cabotegravir than oral Tenofovir and Emtricitabine. Cabotegravir is a new antiretroviral drug (an integrase inhibitor) which can be injected every two months, which allows users not to depend on the daily intake of a pill.
Another option for PrEP currently being investigated are the broadly neutralizing antibodies. Some studies have shown promising results.
Also, research is being implemented to find other forms of delivering PrEP, like subdermal implants of antiretroviral drugs, which would last for one year or even longer.
On top of that, new antiretroviral drugs are being studied for its potential use for PrEP, such as Islatravir, which could be delivered by an implant, or orally once a month.
No doubt than having more PrEP options can facilitate its uptake, by allowing users to choose those option more convenient for them.
Probably, when we have an effective vaccine against HIV, the PrEP will not be necessary anymore, but until then, PrEP has to be accessible to everybody at risk of HIV infection if we want to control this epidemy.
34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
TAMING THE TIDE of STIs & HIV
Bucharest, September 3-5,