Injectable ART to Prevent HIV Transmission While Breastfeeding

For breastfeeding mothers living with HIV, maintaining consistent antiretroviral therapy (ART) is crucial for both their own health and reducing the risk of transmitting HIV to their infants. New long-acting injectable ART options — such as cabotegravir with rilpivirine (CAB/RPV) — can support sustained viral suppression by replacing daily oral medication with an injection every two months, which may also help women keep their diagnosis private.(1^✔ ✔Trusted Source
Long-Acting Antiretroviral Therapy for Breastfeeding Women With HIV Experiencing Barriers to Adherence in Zimbabwe

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Potential Impact of Long-Acting HIV Treatment for Postpartum Women

The study examined potential outcomes in Zimbabwe, where maternal HIV rates are high and LA-CAB/RPV is not yet available outside research environments. Researchers used microsimulation modeling to assess the clinical benefits and cost-effectiveness of offering this long-acting treatment to postpartum women.

There were two main questions we set out to answer: If long-acting antiretrovirals were made available to breastfeeding women with HIV in Zimbabwe, what clinical impact would it have compared to the status quo of daily oral therapies? What is the cost-effectiveness of LA-CAB/RPV, and does this vary based on the level of difficulty women experienced in adhering to oral ART during pregnancy?

We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to simulate how HIV is passed on and how it progresses. This framework enabled us to evaluate the long-term clinical outcomes for a hypothetical group of women and their babies undergoing different treatment strategies — in this case, LA-CAB/RPV versus daily oral ART.

Expanding Access to Long-Acting ART for Postpartum HIV Prevention

Compared to oral ART, LA-CAB/RPV could prevent up to 160 infant infections per year in Zimbabwe. For women whose HIV has not been fully suppressed by their daily pills at the time of delivery, switching to LA-CAB/RPV could be cost-saving if priced at $156/year or lower.

For women whose HIV has already been suppressed at the time of delivery, but who face challenges in adhering to oral ART, switching to LA-CAB/RPV would offer slightly less value, but could be cost-effective if priced at $84/year or lower.

Long-acting ART formulations hold tremendous promise — especially for people living with HIV who struggle with daily oral regimens, and therefore with viral suppression.

We propose that these formulations should be made available globally at an affordable price to ensure they reach the people who may benefit from them most.

Looking ahead, we’ll build on this important work by evaluating the clinical impact and cost-effectiveness of newer long-acting ART formulations, such as long-acting cabotegravir with lenacapavir, among pregnant and breastfeeding women.

Reference:

1. Long-Acting Antiretroviral Therapy for Breastfeeding Women With HIV Experiencing Barriers to Adherence in Zimbabwe - (https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaf521/8362073)

Source-Mass General Brigham