Cabotegravir: A Novel Drug For Prophylaxis Of HIV/AIDS As Pre-Exposure Prophylaxis (PREP)

Abstract

Background: Cabotegravir is a novel integrase strand transfer inhibitor (INSTI) developed for HIV-1 prophylaxis as pre-exposure prophylaxis (PrEP). Given the global burden of HIV/AIDS, there is a critical need for effective, long-acting PrEP options. Cabotegravir's long-acting injectable formulation offers potential advantages over daily oral PrEP regimens, addressing issues related to adherence and resistance.

Method: This review synthesizes the results of key clinical trials, including HPTN 083 and HPTN 084, which evaluated the efficacy, safety, and acceptability of long-acting cabotegravir in diverse populations at risk of HIV infection. The pharmacokinetic properties, mechanism of action, and comparative effectiveness to existing PrEP options are discussed.

Results: Clinical trial data demonstrate that long-acting cabotegravir significantly reduces the risk of HIV acquisition compared to oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). In HPTN 083, among men who have sex with men and transgender women, cabotegravir showed a 66% reduction in HIV incidence compared to TDF/FTC. HPTN 084 reported an 89% reduction in HIV risk among cisgender women. Cabotegravir was generally well-tolerated, with injection site reactions being the most common adverse event. Its long half-life supports dosing every eight weeks, which enhances adherence compared to daily oral PrEP.

Conclusions: Cabotegravir represents a significant advancement in HIV prevention, offering an effective, long-acting alternative to daily oral PrEP. Its high efficacy, favorable safety profile, and less frequent dosing schedule address major barriers to PrEP adherence. Future research should focus on implementation strategies, long-term safety, and cost-effectiveness to optimize its use in diverse populations at risk of HIV infection.