Overview: A New Chapter in HIV Prevention
A long-awaited option for preventing HIV infection is moving closer to routine use in England and Wales. Cabotegravir (CAB-LA), a long-acting injectable that is administered every two months, is poised to become the first injectable form of PrEP (pre-exposure prophylaxis) approved by the National Institute for Health and Care Excellence (Nice). The move aims to expand prevention options for adults and young people who are HIV-negative and at risk of infection.
Why CAB-LA Matters
Traditional PrEP has relied on daily oral tablets. While highly effective for many, some individuals cannot take the daily pills due to medical contraindications, tolerability issues, or personal barriers such as daily adherence. CAB-LA provides a different approach: a monthly-to-bimonthly injection that keeps drug levels constant, reducing the risk of forgetting a dose and potentially improving access for people who struggle with daily regimens.
How It Works and Who Benefits
Cabotegravir is an antiretroviral medication that, when used as PrEP, reduces the likelihood of HIV infection following exposure. The injection is given every two months once a person has completed a required initiation period. NICE’s draft guidance recommends its use for HIV-negative adults and young people at substantial risk, recognizing that this new modality can reach individuals who might otherwise be unable to benefit from PrEP.
Clinical and Public Health Impact
Health authorities point to real-world potential: broader suitability could translate into more people staying protected against HIV, thereby lowering transmission rates and supporting England’s and Wales’ broader public health goals. The UK Health Security Agency (UKHSA) reported that more than 111,000 people accessed PrEP in sexual health clinics in England last year, marking a notable 7% rise from the prior year. NICE notes that around the same number of people in England could benefit annually from CAB-LA, underscoring the injection’s capacity to reach new users while complementing existing prevention strategies.
Official Stance and Timeline
Nice’s recommendation in draft form signals a formal step toward national approval. Health Secretary Wes Streeting described the injection as a “game-changing” development, emphasizing that it offers hope for individuals who cannot use daily oral PrEP. Streeting highlighted ongoing progress in HIV prevention, including a steady rise in PrEP utilization and the country’s ambition to end HIV transmissions by 2030. Once Nice publishes its final guidance later this year, CAB-LA is expected to become available roughly three months after the guidance is finalized.
What This Means for Patients and Clinics
For patients, the injectable PrEP option expands choice and simplifies adherence for some. Clinics will need to adapt workflows to accommodate injections every two months, including monitoring for side effects, scheduling, and ensuring consistent follow-up to maintain protective drug levels. Healthcare professionals will also need to continue education about eligibility, initiation protocols, and transitioning between PrEP methods when appropriate.
Looking Ahead
If approved and implemented, CAB-LA could represent a meaningful shift in how HIV prevention is delivered in England and Wales. By providing an alternative to daily pills, it aligns with patient-centered care and public health strategies designed to reduce new infections. The coming months will reveal how quickly NICE’s final guidance translates into clinical practice and how many individuals take up this new prevention option.
