Long-Acting Injectable PrEP: A New Era in HIV Prevention

A long-acting injectable form of pre-exposure prophylaxis (PrEP) for HIV, cabotegravir (Apretude), is now available in France, marking a significant advancement in HIV prevention strategies. This development addresses limitations of daily oral PrEP, such as adherence challenges, and offers a new option for individuals at risk of HIV infection.

What is PrEP and Why is Injectable PrEP Important?

Pre-exposure prophylaxis (PrEP) involves taking medication to prevent HIV infection in people who are HIV-negative but at risk. Currently available oral PrEP, typically a combination of tenofovir disoproxil fumarate and emtricitabine, is highly effective when taken consistently. However, maintaining daily adherence can be difficult for some individuals, potentially reducing its effectiveness.

Cabotegravir, administered as an injection every two months, offers a discreet and convenient alternative. This long-acting formulation aims to improve adherence and provide sustained protection against HIV acquisition. The World Health Organization (WHO) recommended cabotegravir for PrEP in July 2022, recognizing its potential to significantly impact HIV prevention efforts globally.

Approval and Availability in France

The French High Authority of Health (HAS) validated the medical benefit of cabotegravir in the summer of 2024, though initially classifying the improvement over oral PrEP as “moderate.” Following price negotiations with ViiV Healthcare, a subsidiary of GSK, a government decree on February 26, 2026, paved the way for full coverage of the medication due to its “irreplaceable and particularly expensive” nature. The launch was eagerly anticipated by HIV prevention advocates.

Benefits and Eligibility

The French association Aides welcomed the availability of injectable PrEP, highlighting its potential to reach individuals who struggle with daily oral medication. It provides a valuable option for those with adherence challenges, improving access to this crucial prevention tool.

However, eligibility criteria apply. The HAS currently does not recommend cabotegravir for women of childbearing potential due to a potential risk of fetal malformations. Individuals must also undergo an HIV viral load test before initiating treatment, which may incur some out-of-pocket costs, potentially covered by supplemental insurance.

Cost and Reimbursement

While the list price for a dose of Apretude is approximately 1,000 euros, the actual reimbursed cost by the French Health Insurance remains confidential. The government’s decision to fully cover the medication underscores its commitment to expanding access to effective HIV prevention strategies, despite the high cost.

Key Takeaways

• Cabotegravir is a long-acting injectable PrEP medication offering a convenient alternative to daily oral pills.
• It is now available in France with full health insurance coverage.
• The medication is particularly beneficial for individuals who struggle with adherence to daily PrEP.
• Eligibility criteria exist, including restrictions for women of childbearing potential.
• While the list price is high, the French government is fully covering the cost to ensure access.

Looking Ahead

The introduction of long-acting injectable PrEP represents a significant step forward in the fight against HIV. Continued monitoring of its effectiveness and accessibility, along with ongoing research into new prevention strategies, will be crucial in achieving the global goal of ending the HIV epidemic. Further studies are needed to assess the long-term impact of cabotegravir and to address potential barriers to access for all individuals who could benefit from this innovative prevention tool.