Pareto Points

Cabotegravir: Are We Getting Closer To Becoming HIV Free ?!?

….and what lenacapavir might mean next!

20 October 2025By Pareto Education3 min read

HIV. The world used to shudder at the sound of HIV and it’s primarily complication AIDS.

The world still shudders when hearing about this complex disease but thankfully we have come far in understanding the disease process and have developed a wide range of pre-exposure, post-exposure and treatments that fight the disease.

In the UK, recent data shows there are still thousands of new diagnoses each year. For example, over there were 6,400 new diagnoses in 2023 and significant inequities between groups. National surveillance also reports reductions in deaths among people living with HIV, but new infections still occur and prevention tools remain vital. Treatment isn’t cheap especially when you evaluate it over a persons lifetime. It is estimated to be anywhere between £70 - 120,000 per person which is driven mainly by antiretroviral drug costs and long-term monitoring/complications

The world is trying to become HIV free by 2030 and we may have just had the breakthrough we needed. Preventing new cases is integral for any robust response against disease and despite the effectiveness of pre-exposure prophylaxis, it had its logistical challenges.

Oral PrEP requires adherence (daily or timed dosing), access to clinics/pharmacies, privacy to store and take pills, and ongoing monitoring. Certain groups such as those who were homeless or history of drug abuse would often miss doses which would result in them contracting the disease. Ultimately, despite an increased uptake or PrEP, logistic challenges prevent its effective use

So what is this breakthrough?

Cabotegravir long-acting (CAB-LA) is an injectable integrase inhibitor formulation which is given intramuscularly every 8 weeks(after an initiation schedule). The evidence for its effectiveness is pretty robust with anumber of studies finding it to be more effective than daily PrEP treatment. Despite its cost of £7000 per patient per year, the series of intramuscular injections is recommended by NICE due to its effectiveness and simpler administration with respect to at risk groups. People don’t need to take a pill every day or carry a bottle of tablets; they need to attend a clinic every 2 months (cabotegravir) or six months (lenacapavir).

So what’s lenacapavir? It is a novel capsid inhibitor with an exceptionally long half-life formulated for long-acting subcutaneous injection. As a result of this, it can be given twice-yearly or even yearly which only makes things easier for patients who are considering taken PrEP. This would be an additional option albeit will take some time as it is under review by NICE.

Apretude (cabotegravir) for the Treatment of HIV-1 PrEP

Naturally, the discussion will have to move beyond the injections. The NHS will have to adapt its service provision arms by ensuring mobile clinic, outreach teams, pharmacy/clinic capacity, and data systems. Despite this, these new PrEP options demonstrate how far we have come.

Let’s hope we can keep to the goal of eradicating new HIV diagnoses by 2030!

Until next time

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Our Next CPD Course?…. It’s MSK!

Pain is one of the most common reasons for presentation in primary and secondary care. Most of this is managed by the provision of pain relief but this provides little resolution for patients. Infact, most causes of MSK pain can be diagnosed with simple history taking and examination skills and managed with simple treatment options.

We at Pareto Education present a comprehensive masterclass looking at the principles of diagnosing and treatment of MSK conditions. Mr Kiani, an ACP from a physiotherapy specialises in the management of acute muscle injuries as well as chronic rehabilitation in elderly patients. He was previously part of the diagnostic virtual ward service in the community. This masterclass will cover the following topics: