PrEP Beyond the Pill: New Choices in HIV Prevention at HIVR4P 2024

By: Miguel Ángel López-López

HIV prevention has made significant strides over the past decade, with Pre-Exposure Prophylaxis (PrEP) transforming how we address HIV risk. According to UNAIDS, PrEP can reduce the risk of acquiring HIV by over 99% when used consistently, making it an essential tool in the fight against the virus. But as Dr. Beatriz Grinsztejn, President of the International AIDS Society, emphasizes, “The introduction of PrEP marked a turning point in HIV prevention, but expanding choices is crucial to meet the diverse needs of people worldwide.” At HIVR4P 2024, the focus is on exploring and expanding these options. But what does that look like in practice?

Lenacapavir: A Biannual Injectable PrEP with Promising Results

Lenacapavir is an injectable PrEP administered every six months, showing 100% effectiveness. The PURPOSE 2 study, which involved 3,273 participants across 88 sites in seven countries, reported zero infections with just one injection every six months of subcutaneous Lenacapavir. Although these findings were initially presented during the AIDS Conference in July 2024, HIVR4P offered an opportunity to delve deeper into the results.

Just before HIVR4P began, pharmaceutical company Gilead announced it would release the patent for Lenacapavir in 120 countries with high HIV incidence and limited resources. However, activists and experts argue that this is not enough. Several countries that participated in the study—such as Mexico, Argentina, Brazil, and Peru (where the conference is being held)—are excluded from this patent release.

“The IAS commends Gilead for signing voluntary licensing agreements with generic manufacturers to increase access to Lenacapavir, but we’re highly concerned that these agreements do not cover large parts of the world, including the majority of countries in Latin America,” Dr. Grinsztejn stated.

A Three-Month Dapivirine Vaginal Ring: Potential Improvement Over the Monthly Option

One crucial aspect of expanding PrEP options is reducing the burden on patients. Research into extending the effectiveness of the existing Dapivirine vaginal ring is a promising step in this direction. While the one-month ring was a milestone, the announcement of a three-month option that could provide even better outcomes is significant. Not only is this option effective, but it is also cost-efficient, with distribution expenses estimated at just USD 16.

A recent PrEP choice study showed moderate uptake of the Dapivirine vaginal ring among women in Africa as an alternative to the daily oral pill, indicating potential for broader adoption. 

Refillable Subdermal Implant: An Ultra-Long-Acting PrEP Solution

Another development in PrEP technology is the refillable subdermal implant, which utilizes Islatravir and can offer protection for up to 29 months. While human trials have yet to begin, animal testing has shown positive results, raising hopes for the first ultra-long-acting HIV prevention option.

On-Demand PrEP: Anal Douche as a Delivery Method

The study HPTN 106 is exploring an on-demand PrEP method through an anal douche containing 660 mg of Tenofovir. This method, designed for men who have sex with men (MSM), trans women, non-binary people, and others who engage in receptive anal sex, recognizes that most individuals already use an anal douche before sex. The study showed an 87% acceptability rate among participants, highlighting the potential of this approach.

Monthly Pill: Expanding Long-Acting PrEP Options Beyond Injections

Long-acting PrEP is often associated with injectables, but researchers are also developing a monthly pill using Islatravir as an option for those who prefer to avoid needles. This innovation expands the variety of prevention methods available to meet different preferences and needs.

Long-Acting Hydrogel: Preventing Both HIV and Pregnancy

A promising option in the preclinical research phase is a long-acting hydrogel that prevents both HIV and pregnancy. This biodegradable silica hydrogel depot, injected subcutaneously, combines antiretrovirals Dolutegravir and Cabotegravir with the contraceptive Levonorgestrel. This approach offers three months of protection without requiring cold chain storage, making it particularly suitable for resource-limited settings. Additionally, because silica is fully biodegradable, removing the implant is unnecessary unless there is a reaction, providing an adaptable and sustainable solution.

Call to Action: Advocate for Broader Access and Support Prevention Efforts

The innovations presented at HIVR4P 2024 demonstrate the ongoing evolution of PrEP, focusing on increasing access, reducing the burden on patients, and tailoring options to diverse communities. However, more work is needed to ensure these advancements reach everyone who needs them, especially in countries with limited access.

Join the movement by advocating for expanded access to HIV prevention options in your community. Consider signing petitions or supporting organizations like AVAC, International AIDS Society (IAS), or Prep4All that work towards making PrEP accessible for all. To learn more about how you can get involved or find local HIV prevention programs, visit the HIVR4P website.

With your support, we can push for equitable access and continue to make strides in preventing HIV for everyone, everywhere.


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New HIV Prevention Technologies Effer Greater Choice

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Celebrating Courage: Reflecting on the Intersection of HIV, Mental Health, and Advocacy on World Mental Health Day