Core IM | Internal Medicine Podcast #175 A Revolution in HIV Prevention & The PURPOSE Trials: Beyond Journal Club Segment with NEJM Group
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Apr 16, 2025 The discussion delves into the evolution of HIV prevention strategies, comparing oral PrEP options like Truvada to innovative long-acting injectables. The groundbreaking PURPOSE trials showcase lenacapavir's impressive efficacy, particularly in diverse populations, revealing zero infections among treated cisgender women. Barriers to access and adherence are critically examined, emphasizing the need for equitable solutions. With promising results on the horizon, the future of HIV prevention looks brighter, potentially revolutionizing care for those at risk.
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Adherence Limits Oral PrEP Effectiveness
- Oral PrEP is very effective but only when taken consistently and adherently.
- Adherence challenges and stigma significantly reduce effectiveness, especially in cisgender women in sub-Saharan Africa.
Injectable Cabotegravir Is Superior
- Long-acting injectable cabotegravir outperforms daily oral PrEP in preventing HIV.
- It shows superior efficacy in men who have sex with men and cisgender women populations.
Efficacy vs Effectiveness in PrEP
- Differentiating efficacy and effectiveness is crucial in PrEP.
- Drugs may work well in trials but fail in real-world use due to adherence issues.