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a notable shortcoming: Breakthrough HIV cases are apparently much more likely among those taking injectable versus oral PrEP. Of the Best 2023 Citizen Soldier Your Story Isn’t Over This Is Your Sign Shirt But I will love this 25 people who contracted HIV in the 2,282-person Apretude arm of the injectable-versus-oral PrEP trial among gay and bi men and trans women, six did so after getting their injections on schedule, according to a presentation in Seattle by Dr. Susan Eshleman, a professor of pathology at Johns Hopkins Medicine. Eshleman’s team has not yet calculated the per capita Apretude breakthrough infection rate, but when these researchers initially reported last year that the trial saw seven breakthrough infections (before revising this figure down to six), their calculations suggested that if 10,000 similar men and trans women were followed for one year, 15 would contract HIV despite receiving on-schedule Apretude injections. Apretude.ViiV Healthcare At the same Seattle conference, Hazra reported the first breakthrough HIV case in an Apretude patient outside of a clinical trial. By comparison, nearly four years passed after Truvada’s approval

as PrEP before a breakthrough infection was first documented in someone faithfully taking that drug. To date, there have been a handful of other case-study reports of breakthrough HIV in people taking oral PrEP. However, there has only ever been one clear such case in the Best 2023 Citizen Soldier Your Story Isn’t Over This Is Your Sign Shirt But I will love this major clinical trials including Truvada or Descovy as prevention. All this suggests that for those with a history of taking daily oral PrEP on schedule, switching to Apretude would actually increase their HIV risk; although the absolute risk of infection would remain low. Optimism in the pipeline HIV prevention experts report excitement about the PrEP pipeline and expectations that in the coming decade, more convenient and longer-acting forms will be approved. “I’m wildly optimistic,” said Sharon Hillier, a prominent HIV prevention researcher at the University of Pittsburgh. “We just have to work through how to deliver these interventions and how to be less burdensome for health care systems.” Recommended OUT POP CULTURE ‘Drag Race’ star Jinkx Monsoon slams wave of anti-drag laws OUT POLITICS AND POLICY Kentucky lawmakers pass ban on youth gender-affirming care The Seattle conference heard promising early stage research findings regarding medication-infused suppositories that could be placed into the rectum or vagina up to 48 hours following sex and likely prevent HIV. And researchers are developing implants that could be placed under the skin and emit preventive medication for many months. Gilead is also running major PrEP trials of the drug lenacapavir, which requires an injection only every six months. Dr. Jared Baeten, who leads Gilead’s HIV strategy, said the company hopes to provide initial study results by 2025. But if Apretude’s pacing is any guide, it could be 2030 before lenacapavir is both approved and widely covered by insurers. In the meantime, PrEP advocates continue to express dedication to work with the options currently on the table, albeit within a complex and fractured health care system that proves alienating to many of those most at risk of HIV.

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