A new injectable drug could change the face of HIV prevention and the revolution might start right here 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 told Bhekisisa in July.
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