In the dark of 2021, when no one thought anything important could still happen that year, the United States surprised us. On Christmas Eve, the FDA, the US drug regulatory agency, was the first in the world to announce approval for the use of long-acting injectable PrEP for HIV prevention.

This modality of pre-exposure prophylaxis uses the antiretroviral cabotegravir, a potent last-generation integrase inhibitor, formulated in an injectable presentation, administered intramuscularly, with the first two injections applied at an interval of one month, and bimonthly thereafter.

The use of cabotegravir as PrEP is now approved for cis and transgender men and women at risk of HIV infection, regardless of sexual activity. The drug can be used in individuals weighing more than 35 kg, which allows its use in adolescents.

The FDA’s announcement has once again led the US to take the lead in adopting new HIV prevention technologies. Something similar happened about 10 years ago with PrEP in daily pills.

After the first studies proved the effectiveness and safety of this prevention method, at the end of 2010, in 2012 the use of oral PrEP had been approved in that country. In Brazil, it was only in 2018 that it was our turn to approve oral PrEP.

The FDA’s decision was based on the results of clinical trials HPTN 083 and 084 released last year. In these studies, prevention was compared when oral and injected PrEP were used in different HIV-vulnerable populations.

The results unanimously showed the superiority of cabotegravir, since with it we do not depend on the commitment of good daily adherence to guarantee prevention against HIV infection.

Among gay and bisexual men and trans/transvestite women, the reduction in HIV incidence among those using injectable PrEP was 69% compared to those using oral PrEP. Among heterosexual cisgender women, this reduction was 92%.

The conclusion of the two studies is that both modalities of PrEP are highly effective in preventing HIV, as long as the medications are used correctly. And so, the more different prevention methods there are, the easier it will be to contemplate all different life contexts with some form of prevention. Injectable PrEP is very welcome and suitable for people who do not adapt to existing prevention options.

In the US, the price of arrival for an ampoule of cabotegravir ($3,700) is still quite high, but equivalent to the price of two months’ worth of oral PrEP pills there. Since in Brazil we have a public and universal SUS (Unified Health System), the incorporation of a technology like this depends on a series of evaluations and negotiations between the Ministry of Health and the pharmaceutical industry.

In 2020 alone, about 40,000 people became infected with HIV in Brazil. For thousands of HIV infections to be avoided, we hope that the incorporation of cabotegravir takes less than the 8 years of oral PrEP.

As citizens, we must all demand the modernization of the SUS. Stay tuned and engage in this still embryonic discussion in the country.

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