Story by Kyle Ingram
Art by Emily Pack
Scientists at the UNC-Chapel Hill have developed a new method of HIV prevention that could protect users for up to six months with just one injection.
It’s a major step forward in the field of HIV prevention, which has primarily relied on once-daily oral PrEP medication for the last decade.
For six years, Rahima Benhabbour’s lab in the UNC/NCSU Joint Department of Biomedical Engineering has worked to create an injectable implant that can release HIV prevention medication over a long period of time.
“There’s still about 1.2 million people who get infected with HIV every year,” Benhabbour said. “That’s just unacceptable on so many different levels, and it doesn’t have to happen if there’s good preventative methods.”
In February, Benhabbour’s team, in collaboration with the Centers for Disease Control and Prevention, released a paper showing that their treatment provided 100% protection from HIV for up to six months when tested on non-human primates.
The road to human application for the treatment is long and expensive, though. Benhabbour estimated it could take two years to get through an investigational new drug application with the Food and Drug Administration and three years to get to clinical trials.
Regardless of the wait, it’s an exciting development for infectious disease experts.
“This is really another tool in our HIV prevention toolbox,” Victoria Mobley, HIV/STI medical director with the N.C. Department of Health and Human Services, said. “It’s extremely exciting and will help us in our efforts to end the HIV epidemic.”
In North Carolina, Mobley said HIV cases have hit a plateau.
“Although we’re not seeing a significant increase in HIV and reported HIV cases, we’re not really seeing a decrease either, which is unfortunate,” she said.
In 2021, 1,400 North Carolinians received a new HIV diagnosis, according to the state. In 2019, before the pandemic, the number of new cases was 1,383.
More than 7,000 people in North Carolina used PrEP in 2021, an increase from about 6,000 the year before, according to AIDSVu, a national organization that tracks HIV.
While oral PrEP is effective at preventing HIV, the daily pill presents barriers for many patients. For instance, patients may forget to take it.
“The daily pill works really well for men, but not as much for women just because of the nature of the drugs and how they accumulate in the vaginal versus rectal compartments,” Benhabbour said. “So that gives a lot less forgiveness for women. Men can miss a couple pills and they’re still quite protected, but women, once they miss one or two, their efficacy goes significantly down and they’re no longer protected.”
Financial barriers also play a role in PrEP access. While many patients can find programs to pay for the medication itself, the treatment requires clinic visits and lab tests that many users can’t afford.
“Hopefully with the expansion of Medicaid, we’re going to see some of those barriers removed,” Mobley said.
Patients also face shame and embarrassment related to HIV treatment.
“There’s still the stigma of not wanting to go in and really talk about your risk for HIV and then potentially get a prescription that’s going to have the name of an HIV medication on it if you’re worried about your roommates, your family member seeing it,” Mobley said.
Sometimes, the stigma also comes at the doctor’s office — especially for young people at risk of HIV.
“Either the providers aren’t informed about it well, or they’re not informed about why young people need to be taking it,” said Armonté Butler, who helps connect young people to sexual health resources as an associate director with Advocates for Youth.
Benhabbour hopes that her lab’s treatment could help patients avoid stigma by allowing them to get long-acting injections rather than keeping medication on hand. Given the delivery method of the medicine, Benhabbour predicts the treatment could eventually be self-administered.
The infrequent nature of the treatment could also help provide protection to patients in countries with less access to daily medicine, Benhabbour said.
“The ultimate goal is that it gets everywhere it needs to be, not just in first world countries,” she said.
When Benhabbour first got into HIV research, she said she saw a unique opportunity to help women at risk.
“As a woman from Africa, I feel a connection to the women in Africa who account for over 75 percent of all women in the world who are at risk of contracting HIV and who currently live with HIV,” reads Benhabbour’s professor biography. “We have much to do to help them, and I believe we can do it.”
Although Benhabbour’s treatment isn’t on the market yet, the FDA has approved a different form of injectable PrEP. In December of 2021, Apretude went on the market as the first ever form of injectable HIV prevention. It doesn’t last as long as the treatment developed by Benhabbour’s lab, though, with patients required to get an injection every two months.
As she undertakes the long process of getting her treatment on the market, Benhabbour is optimistic about the possibility of curbing the HIV epidemic.
“It’s a challenging virus, but we’ve come a long way since the ‘80s,” she said. “I think there’s still a long way to go, but hopefully not as long as the past four decades.”
