PrEP is one of the most effective methods we’ve discovered to help prevent HIV. But since PrEP was first approved as an HIV prevention method in 2012, very little about it has changed... until now.
Injectable PrEP represents the biggest transformation in PrEP since we discovered its power to help prevent HIV. Until recently, PrEP has always been a pill you take orally every day, or around planned encounters. Injectable PrEP simply requires one injection every 1-2 months for maximum protection.
Sounds like a straight upgrade to oral PrEP, right? The truth is a little more complicated: while injectable PrEP has some huge benefits, it also has some drawbacks that make it not the best type of PrEP for everyone.
What is injectable PrEP?
Injectable PrEP is a new type of medication to prevent HIV. PrEP stands for “Pre-Exposure Prophylaxis”, which means taking medication before being exposed to a disease to prevent infection.
Injectable PrEP is a category of PrEP medications that are injected into the body instead of taken orally. The first injectable PrEP was approved in the United States in 2023 and approved in Canada in 2024.
There is currently only one type of injectable PrEP available, called Apretude, containing the anti-HIV drug cabotegravir. Cabotegravir is also used as part of injectable treatment for people living with HIV.
Injectable PrEP vs. oral PrEP pills
Until recently, the only types of PrEP available were pills: Truvada, generic versions of Truvada, and Descovy. When taken as prescribed by HIV-negative people, they can reduce HIV risk through sex by around 99%. All of these medications are also taken by HIV-positive people as part of their HIV treatment.
Some factors like cost, dosing schedule and type of protection may affect if someone chooses injectable or oral PrEP. Here’s how the PrEP types compare:
Dosing: Injectable PrEP vs. oral PrEP
Apretude is injected into the buttock muscle every one or two months. Patients starting Apretude have two injections one month apart. After their second injection, they can have injections every two months.
Oral PrEP comes in pill form and is usually prescribed to be taken daily. It can also be prescribed to be taken on a strict schedule around sexual encounters, a prevention method known as PrEP on-demand.
On-demand use: Injectable PrEP vs. oral PrEP
Taking PrEP on-demand means taking PrEP on a strict schedule around planned sexual encounters.
- Dose 1: 2 pills 2-24 hours before having sex
- Dose 2: 1 pill 24 hours after dose 1
- Dose 3: 1 pill 24 hours after dose 2
Oral PrEP is typically prescribed to be taken daily because it can be easier to remember as part of a routine. It also gives people more flexibility with their sex lives, while PrEP on-demand means you have to know about sex in advance. While PrEP on-demand is effective at reducing the risk of HIV, adherence is very important – if someone misses doses, this can make the PrEP less effective. That means their risk for HIV is higher than if they took oral PrEP daily.
Injectable PrEP cannot be taken on an on-demand schedule, but it also isn’t necessary since a single injectable PrEP dose is effective for 1-2 months.
Drug use protection: Injectable PrEP vs. oral PrEP
Apretude is only approved for HIV prevention through sex. If your HIV risk is from injecting drugs then it won’t be a good option for you.
Oral PrEP, taken daily, is approved to help reduce HIV risk when sharing equipment to inject drugs. It is less effective for preventing HIV when injecting drugs than during sex, but it still reduces risk.
Cost: Injectable PrEP vs. oral PrEP
Apretude is the only version of injectable PrEP currently available. There are no generic versions of it yet, which means it is expensive. Generic versions of drugs, like generic Truvada, contain the same drugs as brand versions but are much cheaper.
Because Apretude is more expensive than other types of PrEP, insurance providers may only cover a smaller percentage of the cost. This means the costs you pay could be higher.
Side effects and safety: Injectable PrEP vs. oral PrEP
Injectable PrEP and oral PrEP can have side effects, like any medication. These vary between the different types. A small number of people starting oral PrEP may have diarrhea, nausea, headache and fatigue, but these usually resolve within a few weeks. Oral PrEP can also have a risk of reduced kidney function and bone density, but this risk is low. A recent study of 14,000 PrEP patients found 0.9% had these problems. This risk is lower with Descovy than Truvada and generic versions.
Like any medication, Apretude can have some side effects. The most common side effects of Apretude are diarrhea, fatigue, fever and headache. Another common side effect is injection site reactions like pain and tenderness, swelling, bruising and lumps or bumps under the skin.
Because injectable PrEP stays in your system for a long time, this means that side effects can last longer. This is different from oral PrEP, where side effects can often be resolved quickly by stopping the medication if you need to.
Some people choose to take Vocabria, the oral version of Apretude, as a daily pill for a month first. This way, you can check if your body tolerates the medication before switching to injection.
How effective is injectable PrEP?
Data supporting Apretude comes from two large clinical trials. One study monitored over 4,000 gay and bisexual men and transgender women across multiple continents. Another study monitored over 3,000 cisgender women in sub-Saharan Africa.
Both studies found that Apretude was highly effective at preventing HIV transmission through sex when taken as prescribed. In fact, it was about 60% more effective than Truvada or generic Truvada, which are already proven to reduce HIV risk by 99% when taken as prescribed.
Is injectable PrEP for me?
Apretude can be taken by people of all genders who may be at higher risk for HIV. This includes cisgender women and trans and non-binary people. Clinical trials for other types of injectable PrEP suggest that these newer versions being developed could also be taken by people of all genders.
Some factors like cost, dosing schedule and type of protection may affect if someone chooses injectable or oral PrEP. Here’s how the PrEP types compare:
The benefits of injectable PrEP
- Requires only 1 dose every 2 months
- Slightly more effective than oral PrEP (but both are over 99% effective when taken as prescribed)
The drawbacks of injectable PrEP
- Requires an in-person appointment for every dose
- Much higher cost than oral PrEP — up to 130x more expensive than generic Truvada
- Requires needle injection
- Not approved in reducing HIV risk from drug use
- Side effects can last longer
How do I get injectable PrEP?
In the United States, Apretude is covered by most private health plans and most Medicaid plans. However, the amount you pay towards each prescription (your co-pay) will vary depending on your insurance plan.
Apretude’s manufacturers, ViiV Healthcare, offer a co-pay assistance program for people with insurance. This can help cover up to $7,850 towards medication co-pays each year.
To learn more about Apredute patient assistance programs, visit Viiv’s website.
Injectable PrEP’s future, and staying safe in the present
While Apretude is the first kind of injectable PrEP to be approved in the United States, more are on the way.
Gilead Sciences is currently trialing a new form of injectable PrEP using the anti-HIV drug lencapavir. Gilead’s injectable PrEP is a subcutaneous injection, which means it goes into the tissue just below your skin instead of into your muscle like Apretude does. It also lasts longer, requiring only one dose every six months.
Preliminary data from a clinical trial has shown that this new form of injectable PrEP is 100% effective at preventing HIV transmission in cisgender women. Other studies involving gay and bisexual men, and transgender people of all genders, are currently underway by Gilead and should be complete in the near future.
With so many advancements happening in the HIV prevention space, it might be tempting to wait for the “perfect” form of PrEP before starting. Or maybe you think injectable PrEP sounds appealing, but it’s too difficult or expensive to get.
The best kind of PrEP is the one that you actually take to help protect against HIV. All forms of PrEP available today are effective and safe for most people, and accessing them is easier than at any point in history. If you think PrEP is right for you — whether in injectable or oral form — talk to a healthcare professional to learn about your options.
