New World Health Organisation (WHO) recommendations for the use of long-acting HIV prevention and treatment are a welcome boost in the global efforts to end AIDS as a global health threat by the year 2030.
The WHO announced new guidelines at the opening of the International AIDS Conference in Kigali this week. These include the use of lenacapavir, a six-monthly injectable, as an additional method of HIV prevention, or pre-exposure prophylaxis (PrEP).
“These recommendations are part of a broader effort to support expanded access to person-centered HIV prevention, especially for populations at greatest risk,” says Meg Doherty Director of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at the WHO.
She explains that this recommendation is based on findings from PURPOSE 1 and 2 studies. The research found the drug to be 100% effective in preventing HIV infection in cisgender women and 96% effective in key populations – people at higher risk of being exposed to and acquiring HIV.
The recommendations whill be implemented from 2026.
“This will also help expand coverage for those who are not accessing oral PrEP. It’s going to be helpful in terms of turning the tide in countries that have reached the 95-95-95 targets, but still have significant new infections happening in young adolescent girls and other key populations. This will be part of our solution to get to the end of AIDS by 2030,” says Doherty.
Doctors Without Borders (MSF) welcomed the new guidelines, saying lenacapavir could change the HIV landscape and offers an improvement over existing PrEP options, like the daily oral pill.
But concerns have been raised about the cost of the drug.
“Lenacapavir is the kind of innovation that can be transformative, but only if it is ultimately accessible to communities in low- and middle-income countries that most need it,” says Dr Antonio Flores, Senior HIV/TB Advisor for MSF Southern Africa Medical Unit (SAMU), in a statement.
“MSF works with these communities across many of its projects and if Gilead made lenacapavir more affordable, there’s no question we and other partners would offer it.”
Health Minister Dr Aaron Motsoaledi announced last week that South Africa, which has the highest number of people living with HIV, would be among the first countries to recieve lenacapavir. This was possible through an access agreement The Global Fund signed with drug manufacturer Gilead.
Treatment breakthrough
A second, groundbreaking announment is the recommendation for the use of long-acting injectable cabotegravir and rilpivirine (CAB/RPV) as an antiretroviral therapy (ART). This treatment is recommended for adults and adoloscents who are already on ART and have undetectable viral loads.
“This recommendation, we believe, is important for those who’ve had difficulty with adherence and can be lifesaving,” says Doherty.
A new licensing agreement between the Medicines Patent Pool (MPP) and the pharmaceutical company ViiV laid the groundwork to expand access to long-acting injectable cabotegravir – which has mainly been used for HIV prevention – for HIV treatment.
“Expanding our licence with ViiV Healthcare to include long-acting cabotegravir for HIV treatment marks a significant step forward for equitable access,” Esteban Burrone, Director of Strategy, Policy and Market Access at MPP.
“As the first full long-acting HIV treatment regimen, now recommended by WHO, it answers a long-standing call from communities for an option that would maintain viral suppression without the need for daily medication.”
Globally, around 31.6 million people were on ART in 2024. South Africa has the biggest programme in the world with an estimated 6.3 million people on HIV treatment.
Call to action
Dr Beatriz Grinsztejn, President of the International AIDS society, says these recommendations mark a significant point in the HIV response.
“Our next challenge is clear, leaders must commit the funding and resources needed to integrate these scientific advances into health systems quickly and equitably so that people everywhere can benefit from these life changing options.” – Health-e News
