Injectable PrEP (Pre-Exposure Prophylaxis) for HIV
Table of contents
- Introduction to Injectable PrEP and Its Importance
- What Medication is Used As Injectable PrEP?
- Updated Guidelines for Injectable PrEP
- Advantages of Injectable PrEP Compared to Oral PrEP
- How is Injectable PrEP Administered? What is the Protocol?
- Adverse Events and Side Effects of Injectable PrEP
- Contraindications & Safety Information Of PrEP Injection
- FAQ About Injectable PrEP
Injectable PrEP offers a breakthrough in prevention against HIV infection as, providing a long-acting alternative to daily oral medications. At H.U.M. Clinic, a leading HIV clinic in Bangkok, Thailand, we explore the key aspects of PrEP injection, including Cabotegravir (Apretude) and Lenacapavir (Sunlenca). The current FPA-Approved PrEP injection offers protection with doses administered every 2 months, making it an effective option for those at risk.
By reducing the burden of daily pills, the Injectable PrEP (Pre-Exposure Prophylaxis) for HIV increases adherence and effectiveness, making it a viable option for many. This innovative approach offers a more convenient and effective method of protection against HIV, ensuring comprehensive care for those in need. Learn more in this article about the benefits, guidelines, and safety considerations associated with PrEP injection. When the medication is approved by Thai FDA, H.U.M. Clinic, the HIV Clinic expert, will be the very first clinic to provide PrEP injection in Bangkok.
Introduction to Injectable PrEP and Its Importance
Injectable PrEP is a significant advancement in HIV prevention, offering an alternative to daily oral PrEP. This long-acting injectable solution is particularly beneficial for those who struggle with the daily adherence required for oral PrEP, making it easier to maintain consistent HIV protection.
Why Is Injectable PrEP Needed?
Oral PrEP requires daily dosing, which can be challenging for many individuals. Non-adherence reduces effectiveness, increasing the risk of HIV infection. Injectable PrEP, administered every 1-2 months, addresses this by offering a more manageable, less frequent dosing schedule.
Enhancing HIV Prevention Strategies
Injectable PrEP, such as Cabotegravir (Apretude), provides a discreet and flexible option, potentially increasing PrEP uptake among high-risk populations. By reducing the burden of daily medication, it offers a promising solution to improving overall HIV prevention efforts.
What Medication is Used As Injectable PrEP?
Injectable PrEP utilizes specific medications designed for long-acting HIV prevention. These medications offer an alternative to daily oral PrEP, providing sustained protection with less frequent dosing. Currently, Cabotegravir (Apretude) is the primary medication approved for this use, while other drugs like Lenacapavir are still under clinical investigation.
Cabotegravir (Apretude)
CAB LA (Cabotegravir Long Acting), as marketed as Apretude, was approved by the FDA in 2021 as the first long-acting injectable PrEP medication. It is administered once every two months and provides consistent protection against HIV. This option is particularly beneficial for individuals who may struggle with the adherence required for daily oral PrEP.
Lenacapavir (Sunlenca)
LEN (Lenacapavir), marketed as Sunlenca, is another promising medication for Injectable PrEP, currently in Phase 3 clinical trials as update in June 2024. Unlike Cabotegravir, which is administered bi-monthly, Lenacapavir is being studied for even longer dosing intervals, potentially offering HIV prevention with injections only a few times a year. This could further enhance adherence and convenience for at-risk populations.
Updated Guidelines for Injectable PrEP
The use of CAB LA (Cabotegravir Long-Acting) as an injectable PrEP option has been increasingly recognized in various global guidelines. Below is a summary of the most relevant and recent guidelines, providing a comprehensive view of how this new form of HIV prevention is being implemented worldwide.
- DHHS/CDC 2021: The U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention have recommended CAB LA as an option for individuals at high risk of HIV infection who may have difficulty adhering to daily oral PrEP. This guideline emphasizes the importance of regular injections every two months.1
- IAS/USA 2022: The International Antiviral Society–USA endorses CAB LA for PrEP in populations with adherence challenges to daily oral PrEP. The guideline also highlights the need for careful monitoring of injection site reactions and adherence to the two-month injection schedule.2
- WHO 2022: The World Health Organization supports the use of CAB LA as part of a broader HIV prevention strategy. WHO guidelines stress the importance of offering this option in regions with high HIV incidence and limited access to consistent oral PrEP.3
Advantages of Injectable PrEP Compared to Oral PrEP
Injectable PrEP offers several key advantages over traditional oral PrEP, making it a more appealing option for individuals at risk of HIV. The long-acting nature of injectable PrEP, such as Cabotegravir (Apretude), addresses common barriers to oral PrEP, including adherence challenges and social stigma. Below are some of the primary benefits:
- Enhanced Adherence: Injectable PrEP eliminates the need for daily pill-taking. It is a significant advantage for individuals who struggle with adherence. This ensures more consistent protection against HIV, as the medication is administered once every two months.
- All-Gender Protection: Cabotegravir offers robust protection for all genders unlike the oral PrEP TDF/FTC. This inclusivity makes injectable PrEP a versatile choice for diverse populations.
- Reduced Stigma: Injectable PrEP reduces the visibility of HIV prevention efforts, as it does not involve carrying or taking daily pills. This can be particularly beneficial in environments where there is a stigma associated with HIV prevention methods.
How is Injectable PrEP Administered? What is the Protocol?
Injectable PrEP, specifically Cabotegravir (Apretude), follows a structured protocol to ensure its efficacy and safety. The process includes an initial HIV test before starting the injections, followed by a regular testing schedule during and after the treatment to prevent potential drug resistance. Here’s how the administration works:
Cabotegravir (Apretude) Dosing Schedule
- Initial Dosing: The first two injections are administered one month apart.
- Ongoing Dosing: After the initial doses, subsequent injections are given every two months. Patients have a flexible window of 7 days before or after the scheduled date to receive their injections.
- Missed Doses: If an injection is missed, patients can switch to Cabotegravir oral pills for up to 2 months as a bridge until the next injection.
Lenacapavir Protocol
- Administration Frequency: Lenacapavir is administered once every six months, offering a longer-lasting alternative to Cabotegravir.
- Protocol Status: While Lenacapavir is still in clinical trials, it shows promise as an extended-duration injectable PrEP. Specific guidelines will be made public as the drug completes its trial phases.
Adverse Events and Side Effects of Injectable PrEP
While Injectable PrEP, particularly Cabotegravir (Apretude), is generally well-tolerated, it’s essential to understand the potential side effects and adverse events. This knowledge allows patients to make informed decisions and monitor their health effectively during treatment.
Common Side Effects of Cabotegravir (Apretude)
- Injection Site Reactions (ISRs): The most frequently reported side effect includes pain, swelling, or redness at the injection site. These reactions are usually mild or moderate, and less frequently over time. It can also resolve on their own. Discontinuations due to ISRs were 2.4% (50 of 2,117 participants)
- Mild Systemic Effects: Some patients may experience headaches, fatigue, or mild nausea following the injection. These effects are typically temporary and diminish as the body adjusts to the medication.
Rare but Serious Side Effects
- Hypersensitivity Reactions: Though rare, some patients may experience allergic reactions, including rash, fever, or respiratory symptoms. Immediate medical attention is required if these symptoms occur.
- Liver Function Alterations: In rare cases, injectable PrEP can impact liver function, leading to elevated liver enzymes. Regular monitoring through blood tests is recommended to ensure liver health during treatment.
Contraindications & Safety Information Of PrEP Injection
While PrEP Injection, particularly Cabotegravir (Apretude), is generally well-tolerated, it’s essential to understand the potential side effects and adverse events. This knowledge allows patients to make informed decisions and monitor their health effectively during treatment.
Who Should Avoid PrEP Injection?
- Hypersensitivity: Individuals with known hypersensitivity to Cabotegravir (CAB) or any excipients in the tablets or injection should avoid using Injectable PrEP.
- Medication Interactions: Those taking medications such as rifampicin, rifapentine, phenytoin, phenobarbital, carbamazepine, or oxcarbazepine should not get PrEP Injection. The potential drug interactions could reduce its effectiveness.
Special Considerations for Specific Populations
- HIV Positive or Recent Exposure: CAB should not be used in individuals who are HIV positive or who have had recent exposure to HIV, as this can lead to drug resistance.
- Pregnancy and Breastfeeding: The safety of CAB during pregnancy is unknown, and it may be present in human milk for up to 12 months or longer after the last injection.
- Hepatic Impairment: CAB has not been studied in individuals with severe hepatic impairment (Child-Pugh score C), making its safety in these populations uncertain.
- Age and Hepatic Impairment: The safety and efficacy of CAB has not been studied in children and adolescents weighing less than 35 kg and also the individuals aged 65 years and over, making its safety in these populations uncertain.
FAQ About Injectable PrEP
Is Injectable PrEP available in Thailand as of 2024?
No, as of 2024, Injectable PrEP is not yet available in Thailand. However, oral PrEP options are accessible at various clinics, including H.U.M. Clinic in Bangkok.
How often do I need to get the Injectable PrEP shots?
Cabotegravir (Apretude), is typically administered intramuscularly every two months after the initial doses, which are given one month apart.
How soon after the injection does Injectable PrEP start working?
The injection begins providing protection against HIV approximately 7 days after the first injection. It’s important to follow the injection schedule closely for continuous protection.
What happens if I miss a scheduled Injectable PrEP shot?
If you miss a scheduled shot, you should contact your healthcare provider as soon as possible. You may be advised to switch temporarily to oral PrEP until you can receive your next injection.
