Could six in­jec­tions a year pro­tect you from HIV in­fec­tion?

Lesotho Times - - Africa -

JO­HAN­NES­BURG — A new in­jectable drug could change the face of HIV pre­ven­tion and the rev­o­lu­tion might start right in South Africa.

A clin­i­cal trial ex­pected to start in Cape Town this year will pit a new long-act­ing an­tiretro­vi­ral (ARV) drug against the HIV pre­ven­tion pill. If suc­cess­ful, the study could be the first step to­wards an era in which easy-to-use bi­monthly in­jec­tions could help pre­vent HIV in­fec­tion.

As part of the trial, about 150 South African men who have sex with men and trans­gen­der women will be given ei­ther the HIV pre­ven­tion pill or the ex­per­i­men­tal jab. They will be among about 4 500 par­tic­i­pants in eight coun­tries, in­clud­ing the United States, Brazil and In­dia, who will test whether bi­monthly in­jec­tions of a new ARV, cabote­gravir, works as well as the cur­rent HIV pre­ven­tion pill to curb in­fec­tion.

In 2015, South Africa be­came one of the first coun­tries in the world to in­tro­duce the HIV pre­ven­tion pill as a form of pre-ex­po­sure pro­phy­laxis (PREP). Sold un­der the brand name Tru­vada, the pill com­bines two Arvs. Sev­eral stud­ies have shown that, when the HIV pre­ven­tion pill is taken once a day, at around the same time, it can re­duce a per­son’s risk of con­tract­ing HIV by more than 90%.

The Des­mond Tutu HIV Cen­tre will be con­duct­ing the re­search in Cape Town. Ac­cord­ing to the cen­tre’s deputy di­rec­tor, Linda-gail Bekker , and a fel­low re­searcher of the study, Karen Dominguez, Cape Town will be the only trial site in Africa to test whether cabote­gravir works as well as Tru­vada to pre­vent HIV. re­sults are ex­pected to be re­leased in 2021.

The in­jectable ARV is be­ing tested among men who have sex with men and trans­gen­der women be­cause these two groups are at a high risk of con­tract­ing HIV, in part be­cause they en­gage in anal sex.

“The an­nual num­ber of new HIV in­fec­tions among young peo­ple, es­pe­cially men who have sex with men and trans­gen­der women who have sex with men, has been on the rise de­spite nearly flat HIV in­ci­dence world­wide,” says the trial’s com­mu­ni­ca­tion of­fi­cer, Kevin Bokoch.

The risk of con­tract­ing HIV through un­pro­tected re­cep­tive anal sex is al­most 20 times greater than the HIV risk as­so­ci­ated with vagi­nal in­ter­course, ac­cord­ing to a 2010 study pub­lished in the In­ter­na­tional Jour­nal of Epi­demi­ol­ogy.

Bokoch says re­searchers are await­ing more data to show that the in­jectable ARV is safe to use in women be­fore em­bark­ing on a sim­i­lar trial pit­ting the shot against Tru­vada later this year.

Cur­rently, the HIV pre­ven­tion pill is avail­able in the pri­vate sec­tor. The gov­ern­ment has also be­gun to pro­vide the pill to sex work­ers at 10 sites in an ef­fort to re­duce HIV in­fec­tions among the high-risk group. But the pill only works if taken ev­ery day.

Uni­ver­sity stu­dent Di­neo Twala* be­gan tak­ing Tru­vada in June. Like many who take med­i­ca­tion daily, she says it’s hard to take PREP con­sis­tently.

“To take a pill at the same time ev­ery day, it’s like I am al­ready liv­ing with HIV. It’s hard to swal­low, even though you do it be­cause you know it helps pro­tect you against HIV,” she said.

Bokoch says, if the new ex­per­i­men­tal HIV pre­ven­tion jab is proved to be ef­fec­tive, it could help pro­vide peo­ple like Twala with an ad­di­tional and eas­ier-to-use method to pre­vent HIV in­fec­tion.

*Not her real name — M&G

A new in­ter­na­tional clin­i­cal trial will pit a novel in­jectable an­tiretro­vi­ral against the HIV pre­ven­tion pill to see whether bi-monthly in­jec­tions can pre­vent HIV in­fec­tion.

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