New technologies reduce the chances of HIV infection through the use of specific medications.
Pre-Exposure Prophylaxis (PrEP) consists of the daily use of a combination of two antiretroviral drugs (tenofovir + emtricitabine), which have a composition similar to those used in the treatment of the virus, reducing by more than 90% the chances of a person becoming infected when exposed to HIV.
In addition to oral medications, PrEP can also be performed using an injectable medication called cabotegravir, approved this month by the National Health Surveillance Agency (Anvisa) for use in Brazil.
“Brazil already implements PrEP in the SUS with oral medication, for daily use, with tenofovir and emtricitabine. Injectable cabotegravir arrives as an option that will be very useful for people with difficulty in adhering to the use of daily oral PrEP”, said infectologist Beatriz Grinsztejn, from the Oswaldo Cruz Foundation (Fiocruz), in a statement.
How injectable PrEP works
Cabotegravir is a long-acting intramuscular injectable form of PrEP, with the first two injections given four weeks apart, followed by an injection every eight weeks.
Like oral medications, the injectable version of pre-exposure prophylaxis aims to reduce the risk of contagion if a person is exposed to the virus.
“Injectable PrEP uses a long-acting medication called cabotegravir, an antiretroviral from the integrase inhibitor class that has been tested for pre-exposure prophylaxis and has been shown to be highly effective in preventing the acquisition of HIV infection in the populations in which it has been tested” , said Beatrice.
Efficiency
The World Health Organization (WHO) included the use of cabotegravir as a measure to prevent HIV infection in its PrEP guidelines in July 2022. According to the WHO, the drug has proven to be a safe and highly effective option for people at significant risk of HIV infection.
The drug was shown to be safe and highly effective among cisgender women, cisgender men who have sex with men and transgender women who have sex with men in two clinical trials.
“Cabotegravir has been evaluated in two phase III clinical trials. The first was HPTN 083, which took place in 43 research centers in seven countries. In Brazil we had centers in Rio de Janeiro, São Paulo and Porto Alegre”, he says.
Together, these landmark studies found that use of the drug resulted in a 79% relative reduction in HIV risk compared with oral PrEP, where adherence to daily oral medication proved to be a challenge.
According to the WHO, long-acting injectable products have also been found to be acceptable and sometimes preferred in studies examining PrEP preferences among the community.
“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but it is not yet available outside of study settings,” said Meg Doherty, director of WHO’s Global Programs on HIV, Hepatitis and Sexually Transmitted Infections.
“We hope these new guidelines will help accelerate countries’ efforts to begin planning and delivering CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.”
An international clinical study (HPTN 083), which had the participation of Fiocruz, pointed out that PrEP in the injectable, long-acting form, used every eight weeks, was more effective in preventing HIV infection than common PrEP medications.
The injection contains the antiretroviral cabotegravir, a drug already used to treat the virus. The results were presented at the 23rd International AIDS Conference, held in 2020, virtually due to the Covid-19 pandemic.
common PrEP
Withdrawal of oral PrEP medications is subject to regular consultations with health services. Therefore, every three months, follow-up tests should be carried out to check the reaction to the drugs, in addition to tests for HIV, syphilis and hepatitis B and C.
The medicine begins to take effect between 7 and 20 days of use, depending on the type of sexual intercourse.
PrEP is provided free of charge by the Unified Health System (SUS). The drug can be purchased on the private network, under the trade name of truvada, only with a medical prescription.
HIV in Brazil
More than one million people are living with HIV in Brazil. According to the epidemiological bulletin of the Secretariat for Health and Environment Surveillance of the Ministry of Health, in 2022 alone, more than 16,700 cases of the infection were recorded.
Unlike HIV, the acquired immunodeficiency syndrome, known as Aids, caused by the virus, leads to the progressive loss of immunity.
The more advanced the disease, the more fragile the organism becomes, which becomes unable to defend against so-called opportunistic infections, which can be candidiasis, pneumonia, toxoplasmosis, meningitis, tuberculosis, among others. With the lack of treatment, the patient can reach the most advanced stage of the disease.
In Brazil, the highest concentration of AIDS cases is among young people, aged 25 to 39 years, with a similar distribution, being 52.4% in males and 48.4% in females.
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Source: CNN Brasil
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