A Breakthrough in HIV Prevention: NICE Approves Long-Acting Preventive Injection

All of us are familiar with the Human Immunodeficiency Virus, popularly known as HIV, as it has been one of the most dreaded viruses in the world for a long time. HIV infection has long been one of the world’s most challenging and stigmatised conditions, and despite decades of awareness efforts and scientific progress, misconceptions still surround it.

Once you contract HIV, unfortunately, there is no cure. However, advances in treatment and prevention have transformed HIV infections from a life-threatening diagnosis into a manageable condition. Current treatment is lifelong antiretroviral therapy (ART), which allows individuals with HIV infection to live long and healthy lives. Nevertheless, as the saying goes, “prevention is better than cure”, making the prevention of new infections a victory, and this is where a major new development brings great hope.

HIV and the Ongoing Fight Against Transmission

Once you contract HIV, it attacks your immune system (which protects you from infections and diseases), thereby weakening the body’s ability to fight everyday infections. HIV is of two main types: HIV‑1, which is the most common worldwide, and HIV‑2. If not treated, it can progress to AIDS (Acquired Immune Deficiency Syndrome), which makes even minor infections dangerous. However, since the introduction of pre-exposure prophylaxis (PrEP), there has been great hope in HIV prevention.

If someone is at risk of being exposed to HIV, they are recommended PrEP, which involves taking a daily pill that contains antiretroviral medication to prevent infection. However, this has to be taken consistently every day. For some individuals at risk of HIV, taking a pill might be difficult due to several reasons, such as medical issues, difficulty swallowing tablets, side effects, or challenging personal circumstances like homelessness or partner violence. For such people, this injection brings hope for a more convenient approach.

The First Injectable HIV Prevention Treatment

Recently, NICE (the National Institute for Health and Care Excellence) suggested cabotegravir (Apretude, produced by ViiV Healthcare) as the first injectable alternative for preventing HIV-1.

Cabotegravir belongs to a class of medicines known as integrase inhibitors. Integrase is an enzyme that HIV needs to replicate inside your cells. Cabotegravir blocks this enzyme, thereby stopping the multiplication of the virus and preventing its spread and further establishment of infection in your body. Cabotegravir has to be taken only once every two months and can be given as an injection by healthcare professionals in specialist sexual health clinics, thereby lowering the burden of remembering to take daily pills. Adults and adolescents who are at high risk of contracting HIV via sexual contact and who are eligible for PrEP but find it difficult to take oral pills will be given consideration for the injection.

Helen Knight, Director of Medicines Evaluation at NICE, described the approval as “a significant milestone in HIV prevention”, adding that it demonstrates NICE’s commitment to bringing innovative medicines to NHS patients quickly while ensuring value for money.

The decision was also welcomed by the British HIV Association, which emphasised that vulnerable people's lives, especially those of women and those with other health or social issues, might be significantly improved by this approach.

PrEP was used by over 111,000 individuals in England in 2024, and the rate of new HIV diagnoses has been steadily declining. Experts say that NICE's recommendation of cabotegravir and its impending NHS availability bring England one step closer to its ambitious goal of stopping HIV transmission by 2030.

It is expected that cabotegravir distribution will start three months after NICE publishes its final guideline. This new alternative is a discreet, reliable, and efficient approach to staying HIV-free and could be life-changing for many people who experience difficulties taking daily medication. As science advances, so does the hope that one day, HIV transmission will truly become a thing of the past.

Sources

1. First HIV prevention injection for people unable to have daily PrEP recommended. NICE website: The National Institute for Health and Care Excellence [Internet]. 2025 [cited 2025 Oct 17]. Available from: https://www.nice.org.uk/news/articles/first-hiv-prevention-injection-for-people-unable-to-have-daily-prep-recommended.

   
   

2. Human Immunodeficiency Virus (HIV). Transfus Med Hemother [Internet]. 2016 [cited 2025 Oct 17]; 43(3):203–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924471/.

   
   

3. Kemnic TR, Gulick PG. HIV Antiretroviral Therapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Oct 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513308/.

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