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Long-Acting Injectables Provide Largest Advancement in HIV Care: Antonio Urbina, MD
Lenacapavir and cabotegravir are among the most important advancements in HIV prevention and treatment within the past 10 years.
Antonio Urbina, MD, the medical director for the Mount Sinai Institute for Advanced Medicine 7th Avenue clinic in New York City, spoke about the advancements made in HIV treatment over the past decade, specifically highlighting long-acting injectables as the breakthrough form of treatment and pre-exposure prophylaxis (PrEP) in the HIV space.
This transcript has been lightly edited for clarity; captions were auto-generated.
Transcript
What are the biggest advancements in prevention and treatment of HIV in the past decade?
What I get really excited about are these long-acting injectables, both for treatment and prevention. For treatment, there was an antiviral called Cabenuva that was approved in 2021, and then for prevention, we have 1 long-acting cabotegravir, and that was also approved in 2021, and that's an intramuscular injection every 2 months. But I think the one that's really been kind of a big breakthrough—in fact, Science magazine called it the breakthrough of the year for 2024—was lenacapavir. It's also called Yeztugo. It was approved by the FDA in 2025, and it's the first twice-yearly injectable PrEP. And the data around this was amazing. There [were] a couple of trials that were called the PURPOSE trial. And the PURPOSE 1 showed 100% efficacy. There [were] no HIV transmissions in those that were randomized to Yeztugo. And in PURPOSE 2, which was more cisgender men and more gender diverse individuals, 99.9% were protected.
But let's also zoom out. Over the past decade, we've also seen treatment become prevention, and that's through "U=U" or "undetectable equals untransmittable." Basically, people are diagnosed with HIV, started on treatment, and then their viral loads get to undetectable; they cannot sexually transmit HIV. That's also been, I think, a huge advancement. And then also just the scaling up of PrEP. We saw that states in the US that had the highest rates of oral PrEP coverage saw the greatest decreases in HIV diagnoses. Again, just these long-acting injectables, I think, are another tool that we can use to get more people on PrEP. But the challenge is that, as of 2022, there were 1.2 million Americans who could benefit from PrEP, but only about 400,000 or 36% were accessing it. That's the gap between what science can do and what we're actually delivering to communities.
