The Future of HIV PrEP and One Step to Take Tomorrow

In "The Future of HIV PrEP and One Step to Take Tomorrow," the faculty look ahead to the PrEP pipeline and close with practical advice for clinicians and pharmacists.

Dr. Cocohoba asks which PrEP developments Dr. Urbina finds most exciting. He points first to an annual intramuscular lenacapavir formulation, noting that the data look promising and that one injection a year would be remarkable. Nearer term, he highlights ultra-long-acting cabotegravir dosed every 4 months instead of every 2. Dr. Cocohoba observes that halving the number of yearly injections would also ease clinic logistics, including injection visits and repeated authorizations.

Dr. Cocohoba is also excited about an investigational once-monthly oral option, which could suit people who do not want a needle. Dr. Urbina describes it as a nucleoside reverse transcriptase translocation inhibitor. He notes early data suggest protection begins within about 2 hours. Dr. Cocohoba adds that it would free patients from clinic visits for administration. She stresses that more tools also mean more responsibility for clinicians, who must stay current enough to present every option. Coverage may limit choices, but patients should still feel they made a well-supported decision.

Dr. Cocohoba closes by asking for one change colleagues could make in their clinic or pharmacy tomorrow. Dr. Urbina says new technology is only as good as patient buy-in, and the gateway remains a conversation about sex. He would make asking about sexual activity routine at every visit, followed by asking whether the patient is interested in PrEP. He acknowledges competing priorities but argues that caring about patients' sexual health makes this a simple question worth asking. Dr. Cocohoba agrees and offers her own advice: just talk about PrEP. She notes that a patient who declines today may say yes later, so the conversation should be ongoing rather than a one-time event. Greater diligence, she argues, would normalize PrEP and help people feel more open to receiving it.

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