Highlights

I think three things are affected most in terms of potential growth and reasons of lack of growth. So, still in terms of infections, although black patients are roughly 15/18% of the overall population they still are roughly half of the new HIV patient population yet, when you look at PrEP usage I think they’re only like 10 or 15% of the overall PrEP usage in the States… The second thing is – which leads obviously to the pipeline – is the persistence of PrEP usage dramatically drops off as you’ve probably seen, where in my experience and I think other studies have seen similar experiences, out of the people we start PrEP on after a year only about half of them end up staying on PrEP and it’s been dramatically changed, of course, with COVID where there’s been a huge drop… And last thing in terms of need, obviously the cisgender female growth is really needed. Obviously, the time it takes, the percentage time it takes to get adequate tissue levels and the need to be much more compliant with taking oral medications like Truvada are significantly different than it is with men. So, there’s a real need for a better treatment option in women.

It seems to be definitely more relevant [Descovy use over Truvada] in those people with higher renal risk factors or osteoporosis risk factors, so those particularly older, those with low body mass, those with – for renal disease – co-infection with hepatitis C, those with hypertension and diabetes. So, in that patient population I think it’s particularly relevant. In the younger men who have sex with men, 18 to 25, it’s really quite debatable whether there is a difference at all and in fact New York is where I’m based, our New York State Department of Health actually recommends Truvada as the primary PrEP and not Descovy, based on the lack of definitive evidence of significant decrease in toxicity of Truvada versus Descovy in the majority
of the population.

I mean our experience is that people are definitely interested and make an active conversation because a good number of patients still are not aware that there is an injectable out there. When people do hear about the monthly injectable for cabotegravir the interest drops. The assumption it’s going to be approved every two months will probably double the interest, but I would say about 20% of my patients express some interest in cabotegravir, but when you tell them what’s involved it probably drops to about 10%. The majority of patients are good with taking something orally on a daily basis, especially if it’s just one pill once a day or they are taking other drugs… those who did start it ended up continuing it and liking it for whatever underlying reason that they started in the first place, whether it be freedom to travel more regularly without having to think of pills, or if it means not thinking about being HIV positive even though they take other pills, or whether it be due to toxicities from the laboratory or tolerability issues, they prefer the injection.