Editor’s Note: At the AIDS 2024 Conference, Dr. Albert Liu from the University of California, San Francisco, delivered a keynote presentation on the latest developments in long-acting HIV prevention technologies. Following his talk, he participated in an exclusive interview with Infectious Diseases Frontier. Dr. Liu highlighted that the field of HIV prevention is currently undergoing exciting transformations. Long-acting drugs, such as bimonthly injections and monthly vaginal rings, have already been approved, significantly improving prevention outcomes and reducing patient burden. Additionally, other technologies in development, such as long-acting tablets, HIV implants, and broadly neutralizing antibodies, show immense potential. However, cost and accessibility remain key challenges to widespread adoption. Future research must focus on the safety, efficacy, and community implementation strategies of these technologies while also simplifying delivery processes to ensure these innovations benefit a broader population and advance HIV prevention efforts.01
Infectious Diseases Frontier: What significant progress has been made in the development of long-term HIV prevention technologies? What are the notable advantages of these new technologies compared to traditional methods?
Albert Liu: We are at a truly exciting moment in HIV prevention, with numerous long-acting drugs currently under development. Notably, two such drugs have already been approved: one is a bimonthly injectable, and the other is a monthly vaginal ring. Additionally, there are other promising options in the pipeline, including a once-monthly oral tablet, HIV implants, and broadly neutralizing antibodies.
The development of these long-acting drugs is of great significance for HIV prevention, as they offer patients more diverse treatment options and are likely to further improve prevention outcomes. The approval of the bimonthly injectable and monthly vaginal ring marks a significant step forward in the application of long-acting drugs in HIV prevention. These drugs reduce the burden of frequent dosing for patients, thereby improving treatment adherence and sustainability.
Moreover, other long-acting drugs in development are also worth noting. The once-monthly oral tablet offers a more convenient treatment option, while HIV implants may provide longer-term prevention. Broadly neutralizing antibodies represent an emerging therapeutic approach with the potential for widespread application by neutralizing the virus and preventing infection.
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Infectious Diseases Frontier: What long-term HIV prevention technologies are currently undergoing clinical trials, and what are the preliminary findings? Have any new insights regarding safety or efficacy emerged?
Albert Liu: Research on the long-acting injectable cabotegravir has shown that it outperforms daily oral medications. Excitingly, in comparisons with daily oral drugs, the group receiving the injectable had a significantly lower infection rate. Additionally, we recently received results from the PURPOSE 1 study, which demonstrated that a six-monthly subcutaneous injection of lenacapavir provided 100% protection for cisgender women.
These findings are highly significant for the field of HIV prevention. The introduction of long-acting injectables not only offers greater convenience for patients but also significantly enhances prevention efficacy. Compared to daily oral medications, these injectables can maintain more stable drug levels, reducing the risk of missed doses and forgotten medications, thereby improving patient adherence to treatment.
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Infectious Diseases Frontier: How do you see the practical application of these long-term prevention technologies on a global scale? What factors could influence their widespread adoption and use?
Albert Liu: I believe cost and accessibility will be critical factors. The success of long-acting drugs and new HIV prevention technologies depends not only on their efficacy and safety but also on their affordability and availability. High costs could prevent many patients, especially those in economically disadvantaged regions and countries, from accessing these products. It is crucial to advocate for fair and reasonable pricing mechanisms to ensure that these innovations reach a broader population.
Additionally, the stability and sufficiency of the supply chain are vital for ensuring drug availability. We need to work closely with pharmaceutical companies to ensure they have the capacity to meet global demand. Effective logistics and distribution systems must also be established to ensure timely and accurate delivery to patients. Therefore, governments and society must work together to provide more support and resources for HIV prevention and treatment.
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Infectious Diseases Frontier: Looking ahead, where should future research on long-term HIV prevention technologies focus? What are the main challenges, and how can we overcome them to advance these technologies?
Albert Liu: More research is needed, particularly on some of the newer technologies that are still in very early stages. We need to advance these technologies through Phase I, II, and III clinical trials to test their safety and efficacy in humans. For products that are already on the market, additional demonstration studies are necessary to explore the best ways to introduce them to different populations. Through this research, we can gain a more comprehensive understanding of the potential and limitations of new technologies and how best to integrate them into existing HIV prevention and treatment programs.
