Clinical Report: Can LAI-CAB Sustain Long-Term PrEP Use?

Overview

Long-acting injectable cabotegravir (LAI-CAB) accounted for only 3% of PrEP use in the US, with persistence declining significantly over two years. The study analyzed data from 781,040 patients, revealing that only 23% of LAI-CAB users remained persistent after two years.

Background

HIV continues to be a major public health challenge in the United States, with over 38,000 new diagnoses projected for 2024. Long-acting injectable cabotegravir offers an alternative to daily oral PrEP, but understanding its uptake and persistence is crucial for effective HIV prevention strategies.

Data Highlights

Key Findings

• LAI-CAB represented only 3% of all PrEP users in the US.
• Persistence with LAI-CAB declined from 50% at 1 year to 23% at 2 years.
• 57% of LAI-CAB users remained engaged in PrEP overall after 1 year.
• A greater proportion of LAI-CAB users were covered by Medicaid compared to oral PrEP users (26% vs 14%).
• Female patients had lower long-term persistence on LAI-CAB (13% at 2 years) compared to male patients (25%).
• Older patients showed higher persistence rates than younger patients.

Clinical Implications

The findings indicate that while LAI-CAB is gaining traction, its long-term persistence is significantly lower than expected. Addressing structural barriers and enhancing support for patients may be necessary to improve adherence to long-acting PrEP options.

Conclusion

The study underscores the challenges of sustaining long-term use of LAI-CAB for PrEP, suggesting that simply increasing availability may not be sufficient to enhance adherence.

Related Resources & Content

1. JAMA Network Open, 2024 -- Long-Acting Injectable Cabotegravir Use and Persistence Over 2 Years
2. Open Forum Infectious Diseases — Implementation of Long-Acting Injectable Antiretrovirals for HIV Prevention and Treatment: Factors Influencing Early Adoption
3. Open Forum Infectious Diseases — Initial Virologic Outcomes of Antiretroviral Therapy in Patients Experiencing HIV Breakthrough During Long-Acting Cabotegravir Pre-exposure Prophylaxis
4. Open Forum Infectious Diseases — Assessing Acceptance and Preferences for Long-Acting Injectable Preexposure Prophylaxis (PrEP) Among People Who Inject Drugs in Washington, DC
5. Clinical Guidance for PrEP | HIV Nexus | CDC
6. Guidelines on long-acting injectable cabotegravir for HIV prevention
7. HIV - Technical work
8. Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women | New England Journal of Medicine
9. Extended Analysis of HIV Infection in Cisgender Men and Transgender Women Who Have Sex with Men Receiving Injectable Cabotegravir for HIV Prevention: HPTN 083 - PMC
10. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial - PMC
11. Features of HIV Infection in the Context of Long-Acting Cabotegravir Preexposure Prophylaxis | New England Journal of Medicine
12. Efficacy and safety of long-acting cabotegravir compared with daily oral tenofovir disoproxil fumarate plus emtricitabine to prevent HIV infection in cisgender men and transgender women who have sex with men 1 year after study unblinding: a secondary analysis of the phase 2b and 3 HPTN 083 randomised controlled trial - PMC
13. Long-Acting Injectable Cabotegravir Use and Persistence Over 2 Years | Infectious Diseases | JAMA Network Open | JAMA Network