Having Wide Range of Options to Prevent HIV is Vital

Various promising preventive options for HIV are available, which might prove to be more acceptable and user friendly to people from diverse communities. Long-acting dapivirine vaginal ring that has finally seen the light of the day and is under regulatory approval processes of several countries. This long-acting female-oriented HIV prevention option is designed to be used by women discreetly. This silicon ring protects from acquiring HIV for 28 days at a time. The ring has to be replaced once every month.

Other promising products include long-acting injectable pre-exposure prophylaxis (PrEP) for women and Islatravir as a once-monthly PrEP pill, as well as a promising new method to induce broadly neutralising antibodies (bNAbs) that could help speed HIV vaccine development.

“COVID-19 has disrupted research around the world, so it is especially exciting to see this new progress. These research advances could help significantly strengthen our HIV prevention toolkit”, said Professor Adeeba Kamarulzaman, President of International AIDS Society (IAS); Dean of the Faculty of Medicine, University of Malaya; and Adjunct Associate Professor at Yale University.

LONG-ACTING INJECTABLE

Long-acting injectable cabotegravir (CAB), a new integrase inhibitor, was found to be superior to daily oral TDF/FTC (tenofovir/emtricitabine) in preventing HIV among cisgender men and transgender women who have sex with men as per HPTN-083 studies.

CAB was superior to TDF/FTC in preventing HIV infection in cis-gender women in Africa, as per Interim results, presented by Professor Sinead Delany-Moretlwe of the University of the Witwatersrand, from HPTN-084.

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Women in the CAB group had an 89% lower risk of HIV infection compared to the TDF/FTC group, likely because of the adherence advantage conferred by the once every 8 weeks (2 months) injections.

ISLATRAVIR AS ONCE A MONTH PILL

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Islatravir shows promise of a once-monthly PrEP pill, as per the Interim analysis of a phase-2a study.

Presenting data of an ongoing study assessing the safety, tolerability and pharmacokinetics of oral islatravir in adults at low risk for HIV, Dr Sharon Hillier of Magee-Womens Research Institute & Foundation said that the drug-under-study was found to be safe and well-tolerated.

Preliminary pharmacokinetics analysis of biopsied tissues suggests rapid, sustained and adequate distribution of Islatravir with presence in the blood over time that researchers believe will correlate with protection.

Dr Hillier added that Islatravir could be a potential game-changer. It is a very potent long-acting agent that can be used for HIV prevention or treatment. It is a little more forgiving in case people forget to take a dose on time – even if 2 weeks late they are still within the protective window.

As it is to be taken only once a month it is easier to use and easier to persist with, than the daily oral PrEP. The potential for 12 pills a year – one pill a month – if proved effective – can have a dramatic impact on HIV prevention.

Long-acting injectable CAB has been paired with another injectable medication dapivirine, both injected once a month, for maintenance of HIV virological suppression in those who have an undetectable viral load, as per journalists, Dr Raphael Landovitz, Professor of Medicine at the UCLA (University of California, Los Angeles) Center for Clinical AIDS Research & Education (CARE), informed that.

It now has regulatory approvals in Canada and Europe. He said Cabotegravir is being developed both as part of HIV treatment regimen with dapivirine, and also separately by itself as an injectable PrEP agent. NO ONE SIZE FITS ALL

It is all about expanding the toolbox of prevention options, says Dr Ishwar Gilada, Governing Council Member of International AIDS Society (IAS) and President of AIDS Society of India. No one size fits all.

India is home to 2.35 million people living with HIV (3rd largest number of people living with HIV after South Africa and Mozambique). Although PrEP is yet to be part of India’s public health programme, Dr Gilada firmly believes that it is an important and integrated tool for larger prevention of HIV in India.

There should be no reservations for the use of this medicine-based prevention if there is no reservation for the use of the barrier-based prevention condom. PrEP also works as a confidence builder when couples plan to have a baby.

Having new HIV prevention options alone will not help in ending the AIDS epidemic. Unless the people who need them are able to access and use these interventions, it will not be possible to bend the curve of new HIV infections.

While scientists are burning the midnight oil to design new effective prevention products, public health policies and efforts seem to be failing down the line in delivering these gains to vulnerable populations.

Dr Daniel Were, a global public health specialist from Kenya lists four basic requirements for the optimum rollout of new HIV prevention products:

– an enabling policy environment and centralized coordination – community ownership – investing in understanding the users to create demands framed around their needs, and – user-friendly delivery platforms and unbiased and non-judgemental healthcare providers. As is the case with all diseases, HIV prevention products will have an impact only when people can access them, irrespective of their socio-economic status.

Shobha Shukla – CNS (Citizen News Service)

(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate.

She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Network to #endTB & #endtobacco and #beatNCDs (APCAT Media).

Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)



Source-Medindia