Taking one PrEP tablet every day can be effective against HIV, but this schedule isn’t right for everyone. Injectable PrEP with lenacapavir, administered every six months after a start-up phase, could alleviate this constraint for certain exposed people.
However, it is not yet widely accessible in France, and should not lead to changes in its current prevention alone.
What the injection every six months would change on a daily basis
PrEP is a preventive treatment for HIV-negative people at increased risk of HIV infection. Until now, the best known option is based on a tablet, taken according to a schedule defined with a healthcare professional. Lenacapavir, marketed in Europe under the name Yeytuo, above all changes the rhythm: after initiation, it is based on subcutaneous injections spaced six months apart.
According to the European Medicines Agency, this is not an isolated injection : the start includes two injections on the first day, combined with tablets for the first two days, then two injections every six months, carried out by a healthcare professional. This precision matters, because medical monitoring remains essential.
The expected interest is very concrete: reduce the mental load linked to repeated intakeslimit forgetfulness and facilitate adherence to the prevention plan. Jérôme, a forty-year-old from the Paris region included in the Purpose 5 trial, tells Parisian Sunday having received their injections in February then in August:
“It’s great, I experience it as a liberation.”
His experience illustrates a possible benefit, without summarizing that of everyone involved. He also emphasizes that the injection can remain unpleasant, speaking of a “big sting”.
This option could be particularly useful in several situations:
- Frequent forgetfulness or difficulty maintaining a daily intake;
- Fear of being seen with treatment associated with HIV;
- Irregular access to care, particularly among certain young, migrant or stigmatized people.
These issues tie in more broadly with the inequalities in access to PrEP, already observed with current treatments.
Very high efficiency, but not absolute protection
The European Medicines Agency reports very favorable results in the PURPOSE 1 and PURPOSE 2 pivotal trials: no HIV-1 infections were observed in 2,134 participants receiving Yeytuo in PURPOSE 1 in the primary analysis, and 2 infections in 2,179 people in PURPOSE 2. These data support very high efficiency in tests, without individual guarantee of 100% protection.
The mechanism is different from that of some oral PrEPs: lenacapavir acts at the level of the capsid, a structure which surrounds the genetic material of the virus, to prevent HIV from taking hold in the body. But the main thing is not the biological detail, but the fact that this long duration of action can better fit lives where daily intake is difficult.
A nuance is necessary: well-taken oral PrEP remains a very effective option. The expected advantage of the injection is therefore mainly due to regularity, access and acceptability. Concerning Purpose 5, Gilead communicates on better persistence at one year compared to daily oral PrEP, that is to say more regular and on-time use of the prevention regimen. These results announced by the manufacturer must still be interpreted with caution, because they relate to a communication and not to a detailed independent scientific publication. To better understand this new treatment, True Medical has already presented Yeytuo, injectable PrEP twice a year.
Why its access in France still remains limited
European authorization does not mean immediate and wide availability for French patients. According to The Parisian Sundaylenacapavir remains, at this stage, reserved for participants in the Purpose 5 clinical trial, and Gilead has filed a request with the High Authority for Health to obtain reimbursement. Access will depend on a reimbursement decision and pricethe newspaper citing a cost of more than $20,000 per year in the United States.
The question is therefore not only scientific. It is also practical: who will be able to benefit from it, in what context, with what monitoring, and at what cost for the health system? The European indication targets adults and adolescents weighing at least 35 kg exposed to an increased risk of acquiring HIV-1 through sexual contact, in association with safer sexual practices. The decision to prescribe is based on an individualized medical assessment.
France already has another injectable PrEP: cabotegravir, or Apretude, administered every two months and covered by Health Insurance. This option does not meet exactly the same promise of duration, but it shows that injectable forms are gradually being integrated into prevention. More details on Apretude injectable PrEP available in France.
While waiting for a clear decision on lenacapavir, it
should not stop, replace or space out ongoing PrEP without medical advice. The choice of HIV prevention is made with a health professional, taking into account exposure, lifestyle, possible follow-up and other prevention tools.