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CAB-LA Superior HIV Prevention to TDF–FTC in MSM

Long acting injectable PrEP therapies that are safe and effective are needed to increase options for at-risk individuals.

A recent study conducted by investigators from the University of California Los Angeles Health, in collaboration with the Fred Hutchinson Cancer Research Center, has found that the PrEP therapy, long-acting injectable cabotegravir (CAB-LA), is superior to the daily oral tenofovir disoproxil fumarate–emtricitabine (TDF–FTC) for the prevention of HIV.

Results from the study were published in The New England Journal of Medicine.

“The efficacy of oral preexposure prophylaxis (PrEP) agents is directly correlated with adherence to prescribed dosing,” the authors wrote. “PrEP agents that do not require regular or planned oral dosing may increase acceptability and protection during periods of risk, thereby reducing the risk of HIV acquisition.”

For the study, the team of investigators conducted a randomized, double-blind, double-dummy, noninferiority trial which aimed to compare CAB-LA to TDF-FTC for the prevention of an HIV infection in in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. 

The study included 4,566 participants who were randomly assigned 1:1 to receive 1 of 2 regimens and were followed for a total of 153 weeks.

The team conducted HIV testing and evaluations with the primary endpoint being the incident of HIV infection.

Findings from the study demonstrated that an HIV infection occurred in 52 participants, with 13 being in the CAB-LA group and 39 being in the TDF-FTC group.

Additionally, in the participants in who were diagnosed with an HIV infection after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted.

“This trial showed that CAB-LA was superior to TDF–FTC in preventing HIV acquisition among MSM and transgender women who have sex with men,” the authors wrote. “The logistics involved in implementation of the use of CAB-LA for PrEP will require new consideration. CAB-LA is an effective strategy for the prevention of HIV infection that will expand PrEP options.”