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

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

doi:10.1016/j.lana.2022.100416

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

Lancet Reg Health Am. 2023 Jan 17:18:100416. doi: 10.1016/j.lana.2022.100416. eCollection 2023 Feb.

Authors

Kate M Mitchell^{1

2}, Marie-Claude Boily^{1

2}, Brett Hanscom³, Mia Moore³, Jeffery Todd⁴, Gabriela Paz-Bailey⁵, Cyprian Wejnert⁴, Albert Liu^{6

7}, Deborah J Donnell³, Beatriz Grinsztejn⁸, Raphael J Landovitz^{9

10}, Dobromir T Dimitrov³

Affiliations

¹ MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
² HIV Prevention Trials Network Modelling Centre, Imperial College London, London, United Kingdom.
³ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
⁴ Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁵ Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
⁶ Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA.
⁷ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁸ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
⁹ Center for Clinical AIDS Research and Education, University of California Los Angeles, Los Angeles, CA, USA.
¹⁰ Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

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.

Keywords: Atlanta; Cabotegravir; HIV; Injectable PrEP; Long-acting PrEP; MSM; Mathematical modelling; Men who have sex with men; Pre-exposure prophylaxis; United States.

Abstract

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