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Estimating the impact of HIV PrEP regimens containing long-acting injectable cabotegravir or daily oral tenofovir disoproxil fumarate/emtricitabine among men who have sex with men in the United States: a mathematical modelling study for HPTN 083

Year: 2023
Type: article
Abstract: Background: The HPTN 083 trial demonstrated superiority of HIV pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) among men who have sex with men (MSM). We compared the potential population-level impact of TDF/FTC and CAB among MSM in Atlanta, Georgia. Methods: An MSM HIV transmission model was calibrated to Atlanta-specific data on HIV prevalence and PrEP usage (percentage of uninfected MSM on PrEP), assuming only PrEP-indicated MSM used PrEP. CAB effectiveness (efficacy × adherence) of 91% was estimated using data from HPTN 083 and previous TDF/FTC trials. We estimated HIV infections averted over 5/10 years if TDF/FTC use were maintained, or if all TDF/FTC users switched to CAB in January 2022 (vs. no PrEP or continued TDF/FTC use). CAB scenarios with 10%/20% more users were also considered. Progress towards Ending the HIV Epidemic (EHE) goals (75%/90% fewer HIV infections in 2025/2030 vs. 2017) was estimated. Findings: We predicted TDF/FTC at current usage (∼28%) would avert 36.3% of new HIV infections (95% credible interval 25.6-48.7%) among all Atlanta MSM over 2022-2026 vs. no PrEP. Switching to CAB with similar usage may prevent 44.6% (33.2-56.6%) infections vs. no PrEP and 11.9% (5.2-20.2%) infections vs. continued TDF/FTC. Increasing CAB usage 20% could increase the incremental impact over TDF/FTC to 30.0% over 2022-2026, getting ∼60% towards reaching EHE goals (47%/54% fewer infections in 2025/2030). Reaching the 2030 EHE goal would require 93% CAB usage. Interpretation: If CAB effectiveness were like HPTN 083, CAB could prevent more infections than TDF/FTC at similar usage. Increased CAB usage could contribute substantially towards reaching EHE goals, but the usage required to meet EHE goals is unrealistic. Funding: NIH, MRC.
DOI: 10.1016/j.lana.2022.100416
Authors: Kate M. Mitchell, Marie-Claude Boily, Brett Hanscom, Mia Moore, Jeffery Todd, Gabriela Paz-Bailey, Cyprian Wejnert, Albert Liu, Deborah J. Donnell, Beatriz Grinsztejn, Raphael J. Landovitz, Dobromir T. Dimitrov
Institutions: Imperial College London, Fred Hutch Cancer Center, Centers for Disease Control and Prevention, University of California, San Francisco, San Francisco Department of Public Health, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, University of California, Los Angeles
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $4,000
Funders: European Commission, Foreign, Commonwealth and Development Office, National Institutes of Health, Centers for Disease Control and Prevention, Medical Research Council, National Institute of Allergy and Infectious Diseases, European and Developing Countries Clinical Trials Partnership
Awards: G1052272520, G127891921, The FIOCRUZ Therapeutic and Prevention HIV/AIDS Clinical Trials Unit (FioTrials), G2347075150, MRC Centre for Global Infectious Disease Analysis, G3166327464, UCLA AIDS Prevention and Treatment Clinical Trials Unit, G393184570, G4926557987, G6520098237, G7063735130, The FIOCRUZ Therapeutic and Prevention HIV/AIDS Clinical Trials Unit., SDMC: HIV Prevention Trials Network, San Francisco Bay Clinical Trials Unit (CTU), UCLA AIDS Prevention and Treatment Clinical Trials Unit
OpenAlex ID: W4316810221
FWCI: 4.526
Cites: 24
Cited by: 22
Related to: 10