Researchers from Massachusetts General Hospital have published a study in the Journal of Infectious Diseases examining the potential benefits of long-acting injectable antiretroviral therapy (ART) for breastfeeding women with HIV in Zimbabwe. The lead and senior authors, Sujata Tewari and Dr. Andrea L. Ciaranello, used microsimulation modeling to assess both the clinical impact and cost-effectiveness of offering long-acting cabotegravir with rilpivirine (LA-CAB/RPV) compared to standard daily oral ART.
The study focused on Zimbabwe due to its high maternal HIV prevalence and the current unavailability of LA-CAB/RPV outside research settings. According to the researchers, “For breastfeeding women who have HIV, consistently taking antiretroviral therapy (ART) is essential for their own health and the health of their infants. New long-acting (LA) injectable ART options, such as LA cabotegravir with rilpivirine (CAB/RPV), can help women suppress the HIV virus within their bodies - keeping them healthy and reducing transmission to their infants. Instead of daily oral pills, the injection is received every two months, making it easier for women to sustain treatment during the postpartum period and keep their medical diagnoses private.”
The team used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to simulate HIV transmission and progression among hypothetical groups of women and infants under different treatment scenarios.
Their findings indicate that using LA-CAB/RPV could prevent up to 160 infant infections annually in Zimbabwe when compared to oral ART. For women whose HIV was not fully suppressed by delivery, switching to LA-CAB/RPV would be cost-saving if priced at $156 per year or less. For those already achieving viral suppression but struggling with adherence, switching would be cost-effective at a price point of $84 per year or lower.
The researchers stated: “Long-acting ART formulations hold tremendous promise - especially for people living with HIV who struggle with daily oral regimens, and therefore with viral suppression. We propose that these formulations should be made available globally at an affordable price to ensure they reach the people who may benefit from them most.”
They plan further research on newer long-acting ART options, including combinations such as cabotegravir with lenacapavir, among pregnant and breastfeeding women.
