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Updates in HIV PrEP Therapy Options

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0:00 | 39:40

Recent developments in HIV prevention — including the FDA approval of a 6‑month injectable option and updated clinical guidance — are changing the landscape of Pre-Exposure Prophylaxis (PrEP) therapy. This course reviews the latest developments, compares prevention strategies, and examines how these changes affect PrEP delivery, counseling, and monitoring. You will gain timely insights to better counsel patients, support adherence, and contribute to prevention strategies in your practice.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
David Hachey, PharmD, AAHIVP
Professor 
Idaho State University 

 
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CPE INFORMATION
 Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe key new HIV PrEP therapy options recently approved or recommended, including their dosing schedules and clinical indications.
2. Identify pharmacist responsibilities when counseling patients about PrEP, including initiation, adherence, monitoring, and risk-benefit discussions. 

Rachel Maynard and David Hachey have no relevant financial relationships to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-26-049-H01-P
Initial release date: 2/9/2026
Expiration date: 2/9/2027
Additional CPE details can be found here.

SPEAKER_00:

Hi, Healthmart Pharmacists. From your education partner CE Impact, this is Game Changers. I'm your host, Jen Moulton, and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.

SPEAKER_01:

There's been a lot of focus recently on preventing HIV transmission among patients at risk. In 2023, about 39,000 people received a diagnosis of HIV in the US. But there are steps we can take to raise awareness and increase the use of PrEP for eligible patients. And there are several medication options available for PrEP, including oral tablets taken daily and injectable forms given by a healthcare provider. And recently, a new injectable product, Lenicapavir, was approved for HIV PrEP, and it's given every six months. So this leads to some interesting questions about the role of this product, especially when adherence to daily oral meds is a concern, and the role of pharmacists in supporting patients with PrEP. And this is actually a two-part series on our podcast talking about HIV prevention. So this week we're discussing HIV pre-exposure prophylaxis or PrEP. And next week we'll be tackling post-exposure prophylaxis or PEP. So to help us all get on the same page about PrEP and where this new injectable product will fit in, I'm so pleased to welcome our guest today, Dr. David Hashey. So welcome, David.

SPEAKER_02:

Thank you.

SPEAKER_01:

So David, maybe you could just start us off by introducing yourself, sharing a little bit of background about you and your current role and why you're interested in this topic.

SPEAKER_02:

Yeah, absolutely. So I've been a pharmacist for nearly 30 years, and I practice in a family medicine residency program. So I train physicians as well as pharmacists. But I've been in a role of an HIV clinical position for nearly 30 years. And over that time, we haven't had a lot of tools to prevent people from contracting HIV. It's always been pulling them out of the river as opposed to preventing them from falling in the river. And since we've had access to preventative strategies with medications since 2012, when the first product was FDA approved, it's been a strong interest of mine of training others in how to utilize these products to prevent the spread of HIV.

SPEAKER_01:

Absolutely. And I think more and more we're seeing pharmacists becoming a really integral role in PrEP, not only supporting patients in counseling, but also initiating PrEP and administering some of these medications as well. Lots of states passing laws to enable pharmacists to really take an empowered role here. So I think it's great to have your expertise and your passion for this topic. And so thank you so much for taking the time today to join us.

SPEAKER_02:

You bet.

SPEAKER_01:

All right. Well, let's get our users and listeners on the same page and just think about what PrEP is, just an overview of what it is, how you would explain it to a patient perhaps, and what it's intended to do and maybe how effective it is as well.

SPEAKER_02:

You bet. When we talk about risk of contracting HIV in the US, we think primarily of individuals that have unprotected sex. And the greatest at-risk population are men who have sex with men, typically receptive anal sex, but certainly women are also at risk. And uh generally receptive vaginal sex is a risk of contracting HIV and then injection drug use. And so all three of these populations, when we talk about sexual health, when we talk about substance use disorders, those are difficult topics to navigate with patients. And once we learn how to converse better with patients and identify potential risks, then we can introduce these products to reduce the likelihood of contracting HIV, which also dovetails into the HIV national aid strategy in reducing and eliminating HIV by 2030. In 2020, it was it was introduced, and certainly the COVID pandemic created some bumps in this, but is to reduce the new infections, as you pointed out, close to 40,000 a year down to about 3,000 a year. And these are the tools that can help reduce the likelihood of contracting HIV.

SPEAKER_01:

Excellent. So yeah, to summarize, that is where some of that focus that I mentioned is coming from is that strategy and working really to reduce the risk of acquiring HIV in the first place and people who do not have HIV using these antiretroviral medications, right, to prevent transmission is the concept.

SPEAKER_02:

Yes.

SPEAKER_01:

And how effective are these medications in preventing HIV transmission?

SPEAKER_02:

That's a great question. And as we know with other medications, a lot of it depends on adherence. Uh and when we go back to the early studies with oral PrEP, those studies in different groups showed that with near-perfect adherence, the medications were greater than 90% effective at reducing the likelihood of acquiring HIV. And then with the introduction of the first long-acting injectable, Cabotegra, that actually showed similar rates. And individuals that had on-time injections were had strong likelihood of remaining free from HIV. And then again, the game changer that really came across was Lenicaprovir. And Lenicapravir is has a unique mechanism of action. It's referred to as a HIV capsid inhibitors, the sort of first in class, if you will. And this one in both men and women appears to be close to 100% effective at reducing acquisition of HIV, again, with on-time injections and avoidance of significant drug interactions. So these products are great. The problem is getting them in the hands of patients and removing the barriers, whether it's, as I already alluded to, whether it's having those tough discussions of removing stigma, removing shame, having open conversations about sexual activity, sexual behavior, substance use, so that patients feel comfortable either asking for or providers are educated and aware enough to inform patients of the tools that they can use to reduce the likelihood of contracting HIV. So to summarize the products, regardless of what you use, if used appropriately, it is going to be greater than 90% effective at reducing likelihood of contracting HIV.

SPEAKER_01:

Okay, that's a great summary and overview. You touched on a few things I want to circle back to. We're going to get into more detail about the options specifically, and you highlighted a few key points with Linux Hapavier, which is that newest option, the injectable. And you also highlighted some of the patients that we may be thinking of as potential candidates for PrEP. So maybe you could talk about that a bit more in detail. Are there certain discussions that we'd want to have or questions we want to ask or patient eligibility criteria, or is this sort of a you know offer to all and allow them to opt in? What can you tell us about that?

SPEAKER_02:

Yeah, that's that's a great question. And and and the first thing that should be, I think, recognized is any patient that walks in asking for prep should be provided with an option. Without getting into, well, why do you want it? Right. What are you doing? Again, that's the shame language that can be used that will prevent people from even asking about it in the first place. So if somebody brings it up, remove the barriers, how can I help? How can we process? Here are areas where you can access it and get it. So that that I'll say is is the first step. Uh second is going to be individuals who engage in unprotected sex. Now I mentioned both men and women, and these individuals can be identified if somebody has a uh uh is being treated for an STI. Maybe they identify as having multiple sexual partners with unprotected sex, and and those individuals, again, should be offered or educated about the options. Now, one caveat is not every agent is approved for women with unprotected vaginal sex. So just as a caveat, the tinofavir, aliphenamide, and tricytabine combination, also referred to as Descovi, is not approved for vaginal sex. But besides that, other patients that inject drugs. So injection drug use, as we know, is a strong risk factor for contracting HIV. And all the modes of prevention, tonofivir disoproxal fumarate and m tritytabine, also referred to as truvata, that is available generically. And then the cabotagravir long acting or apertude, uh, that one also can be used in individuals who inject drugs. So those are going to be our target populations if we identify those. And any way that we can again help educate patients, whether it's through education campaigns or putting information up in, for example, STI clinics or in environments where people may have those risks, such as you know, MAT clinics where a lot of people have a history of injection use or may relapse. So I think there are opportunities to bring awareness to providers and caregivers in certain areas that can increase the uptake.

SPEAKER_01:

Yeah, and again, you brought up a lot of great points there. I think, as you said, raising awareness is so important because I imagine I don't know any statistics around this, and maybe you do, but I imagine there's a large group of people who aren't aware that there are options available to prevent transmission that that PrEP exists, basically. Like I assume there's a fair number of people that aren't aware. And so raising awareness from, you know, having those as you're having those conversations with patients in the pharmacy or in other practice settings, and regardless of the risks a you know, a patient may have, making them aware of these options is a can probably go a long way. Have you seen that in your in your practice? And and how has that sort of come to light?

SPEAKER_02:

So so excellent question. And the the first thing I think we need to step back is go back to those 39, 39,000 individuals that you identified that contracted HIV. Who are those people? Right. And so that's the first question that we need to ask. And when we look at the when we look at the demographics of the most impacted people and states in the country, the people tend to still be young individuals between 18 and 30, uh tend to be African American and the and tend to be men who have sex with men. And the highest rates of HIV in the country are are in the southeast. And and so when uh when we look at this on a national level, we do need to focus efforts in in that environment. Uh but speaking to the larger, I think, pharmacist community that that may be sort of engaging with this, is any opportunity to have a conversation about reduction is critical. And I would say more so in in my community practice, I actually also, despite working in a clinic, I also work as a community pharmacist, is taking those opportunities when you identify patients being treated for chlamydia or gonorrhea in that level of educating them of uh of individuals who are at risk for contracting sexual transmitter disease, such as chlamydia and gonorrhea, are also at risk for HIV. And there are prevention strategies. And providing that information, I think, at the point of counseling is a way for, again, a single point of touch. But it's the broader perspective of teaching medical providers who are going to be the main prescribers, whether it's physicians, PAs, NPs, identifying people that want to engage with that. So again, it's a I think a tough, tough question to answer specifically, but using public health approach, using using stakeholders in the community that may work with organizations, with, for example, if there's a large gay population in your community, working within those communities, pride events, those things that can help spread the word about HIV prevention.

SPEAKER_01:

Excellent. You highlighted a few really good opportunities there. So let's let's go back to those treatment options. And you did bring up all four of the options we have. So two oral products and then two injectable products now. Let's start with the options that we had available until this most recent Lenicapavier was approved for prep. So just to orient us all again on the two oral forms and then capatography or just high-level overview of how they compare pros and cons of each and sort of where we've been before we had the new option and pros and cons of those different existing options.

SPEAKER_02:

Yeah, so that's that's gonna be a mouthful, but let me see if I can't uh let me see if I can't distill it down. Uh as I mentioned, 2012 was the first FDA approval of truvada for PrEP. And that's again tonofivir disoproxal fumarate and n-trisitabine. As with any sort of new new product, new concept, uh, there was a huge lag in uptake. Patients have been the main drivers of going in and asking for it, and providers not being aware are a little hesitant of prescribing antiretrovirals. What is this? How do I do this? But the use of that product, and now that it's available generic, is by far the most affordable. And because there are other administrative and cost and insurance barriers of getting the long-acting injectables, probably still the most highly utilized product for HIV prevention. Subsequent to that, Descovy or Tinofavir aliphenamide and m trisitabine was was approved for HIV prevention. And that has, again, similar indications as to the TDF FTC, and that includes men who have sex with men, injection drug use. But as I mentioned earlier, discovy or tonalfavir aliphenamide combination is not approved for vaginal sex. Then after the oral therapies, the introduction of cabotegravir, long-acting injectable was made available again, first for the treatment of HIV, and then it was studied for the prevention of HIV, similar to Lenicaprovir. And with this product, the benefit of not needing to remember it every day, and the ease of getting an injection every two months is nice for some patients. But again, it's not for everybody. There are some people that may only engage in high-risk activities a few times a year. And therefore, they can use something like tonofivir disaproxyl fumarate and tricycytabine or truvata as sort of an on-demand. Now, this is not FDA approved, but this is again endorsed by and supported in some of the CDC recommendations, where individuals will use two tablets around the time of sexual intercourse. That's the most common. Then followed by one tablet 24 and 48 hours later. So individuals can have different approaches with the oral tablets, but the need for on-time injections is pretty critical with Cabotag Revere and finding an office that will inject it because it is a three-mil injection given into the gluteus and cannot be self-administered. So that is one of the caveats. And there are some other nuances there as well that are more in the weeds than the high level.

SPEAKER_01:

Very good. Well, you you did a great job of that touch, you know, high touch point summary. Yeah, and I think one of the big differences that stands out to me from what you just described is the fact that the oral products are tablets taken daily, once daily, versus or on demand, as you said, or the cabitagravir injectable is every two months given by a healthcare provider, and you called out the the high volume there as a consideration. So good overview there. In terms of tolerability differences or considerations between the tonal, I think that's probably a common question is the difference between the tenophaviralphenamide and the disaproxyl fumarate products. Maybe you can speak to that if there's any significant difference to be aware of, or especially given the cost comparison as you mentioned.

SPEAKER_02:

Yes, the tolerability of the oral agents is incredible. When when you look at clinical studies with those products, whether it was in treatment of HIV and prevention, the complaints of any adverse effects are extremely low, less than 5% for really anything. And they're usually self-limiting side effects, the nausea, the upset stomach, the headache, those types of things. But from a toxicity standpoint, tenophivere disaproxyl fumarate or truvata can have some kidney abnormalities. So patients that are on that need to have a baseline creatinine clearance that is, I believe, above 50.

SPEAKER_01:

But tonophavir aliphine, actually, just to clarify.

SPEAKER_02:

Yep, yep. Thank you. And the tonophavir aliphenamide can be initiated in individuals down to creatinine clearance of 30. And when we when we look at those products, there are again monitoring. That's a simple monitoring parameter that can be identified as patients are monitored on that. And in regards to the tolerability of the current long-acting injectables with cabotagra or apertude, that that agent most of the time is injection site reactions. So soreness in the gluteal area for maybe one to three days. But as individuals get repeated injections over time, that complaint seems to diminish over time, that soreness. And as far as other concerns with cabotegra and the tenophilia aliphenamide, in some areas you will see weight gain associated with those products. And that can be modest in the area of a few kilograms over the course of a year.

SPEAKER_01:

Okay. So the main message I'm hearing is well tolerated across the board, despite some of those potential side effects that we medications in general have side effects. And so that those are things to be aware of and to talk to patients about, but not something to dissuade a patient from starting one of these options and helping to set realistic expectations about what to expect, I think is the most important factor there.

SPEAKER_02:

Yes.

SPEAKER_01:

Okay, excellent. And and you mentioned again that difference between the tenophavir aliphenamide and disapproxal fumarate salts. So uh some subtle differences there in terms of renal function, but assuming that is not an issue, either one is an option for most patients. And and again, I guess the the indication as well in terms of who the aliphenamide form is approved for, not for vaginal receptive sex.

SPEAKER_02:

Yes, yes, that that's that's all correct. And I I think this is probably a good segue into identifying who is can't who is a candidate based on workup. So if we're if we're identifying a patient, patient comes in and says, hey, I I want to be on prep, or the provider recognizes that they're on prep, what needs to be done before they get tablet in their mouth or an injection? And the the most the most critical feature is identifying that the individual is in fact HIV negative. Right. And the main way that is done is with an antibody antigen test. A lot of pharmacists may be familiar with point of care tests. The point of care tests are very accurate. However, there tends to be a little bit of a lag with a point of care test if somebody has had an exposure, an acute infection, that that may be up to three weeks before that test turns positive. So if if pharmacists are engaging in in initiating these products, what's uh what's ideal is having an HIV viral load. An HIV viral load is the is the first uh blood test that will identify somebody has HIV. And that is usually detected within um within a week after infection. And then the next test to turn positive would be a lab-based antibody antigen test, we typically refer to as a fourth generation blood draw, but that would be the minimum that somebody should use in screening for HIV or identifying. And if those are negative and the patient doesn't have any signs or symptoms of acute HIV with recent exposures, so those are the other questions to ask. Have you had any recent exposures of unprotected sex or injection drug use? As long as that test is negative, the other things that we look for, we'll do baseline kidney function screening. It's important to look at hepatitis B status. It's the tonofivir and m-tricytaine are both active against hepatitis B. And if an individual does have hepatitis B, but that is not screened for, then the medication can suppress the virus. And if they come off the medication, they can get a flare and can have some uh potential compromise on a hepatic level. So, with that being said, patients need to be screened for for hepatitis B. And if they are hepatitis B negative, making sure that they get vaccinated. Another important role, I think, of a pharmacist in this in this scope is to engage in other vaccine preventative illnesses, HEP A, HEP B are the main ones. And then a screening for other STIs, it would be recommended to screen for syphilis. And then again, as long as everything is uh comes back appropriate, initiating whatever therapy you identify as appropriate with the patient.

SPEAKER_01:

Yep, excellent. So yeah, the baseline assessment is very important. And in particular, I like that you highlighted the HIV screening because we would not want a patient to be starting these medications for prep if they do have HIV, because these are not a treatment.

SPEAKER_02:

They're not complete regimens, correct?

SPEAKER_01:

Exactly, complete regimens, exactly, right. So that's a very important point to be aware of. So we've talked about the prior prep options, and now we've talked about the baseline sort of assessment, and then where does this new Lenicapavir product fit in? And what are, again, doing that little pro and con comparison, what are some considerations with this versus the prior options that we had?

SPEAKER_02:

Yeah, you bet. I I think the the main barrier of the new agent, as with a lot of products, is cost and access. And anytime there are significant barriers, that generally, a lot of times patients and providers are going to take the path of least resistance. But with that being said, the the cost of this product is about$30,000 annually, at least a you know, sort of the listed price.

SPEAKER_01:

So that's$15,000 in injection and insurance is because it's every six months, just to reiterate that it's an every six month injection. So to reiterate, and so yeah, that works out to$15,000 per injections, which is staggering, but yeah.

SPEAKER_02:

So with that, if a patient can get it approved through insurance and and and initiate it, there are a few things to keep in mind. First of all, identifying drug-drug interactions. As pharmacists, uh, this product is a major substrate for cytochrome P4503A4. And as long as the patient is not on any strong inducers, such as some of the rifamycins, I also think of things like uh carbamazepine. As long as they're not on any major inducers that could lower that level, then they're generally fine. Uh, but if a patient needs to be treated, for example, with a rifamycin for for TB or their carbamazepine is their main medication for for epilepsy, then you're probably going to want to look at other products. And the injection site reactions with lenacaprivere can be quite pronounced. The main issue is a nodule, sort of a depot nodule that you'll hear it described as that can last up to up to a year. And it can be quite discomfort, can be quite a bit of discomfort for the patient. There have been some strategies that can reduce that. So icing the area for about 10 minutes prior to the injection, following the injection recommendation specifically at that 90 degree angle. And so some of those strategies can help ensure or minimize the likelihood of the injection site reaction. Otherwise, patients may also complain of a little bit of nausea. Like I said, with the other products, tends to be, tends to be self-limiting.

SPEAKER_01:

Um I'm glad you called out the injection site reactions and that nodule in particular. And just to confirm, it is a subcutaneous injection. And I I saw you, for our listeners who who aren't seeing the video, I saw you pointing to your abdomen. And so that is where it's injected by a healthcare professional again. So not something that a patient would self-inject, but subcutaneous injection in the abdomen. But being aware of that nodule, that's a little bit different side effect to be aware of and to talk with patients about.

SPEAKER_02:

Yeah. And and as we talk about sort of expanding the practice of pharmacists and some pharmacists in different states have different latitudes. And in the current state that I'm in, I have some pharmacists that are actually doing the injections. Yep. And so I think this is maybe a good opportunity to talk about pharmacist-driven prep clinics. Yes. It's uh the it it is, I think, within the scope of pharmacists, whether it's through collaborative practice agreements or your state's ability for a prescriptive authority, that as long as you have the access to be able to screen for those important pretreatment variables and on-treatment monitoring, which is not a whole lot, that that pharmacists can educate, initiate, administer, and monitor this in a setting that pharmacists, whether it's a you know an advanced community setting, um, I just think it would be hard in some of the general community settings that a lot of people may be used to, but an advanced community setting where there again might be some support with either other providers or you may have the privacy of rooms or access to, again, an environment that is more supportive or conducive to this. So I again I don't think the pharmacist's role in this is just acquisition of a product, which a lot of times is going to be a main supportive role, but can be in that of identifying appropriate patients, prescribing and administering.

SPEAKER_01:

Absolutely. And I think we've seen so much of that with the legislation being passed in various states. I I want to say it's about 20 states that either allow pharmacists to initiate PrEP and sometimes PEP, also post-exposure prophylaxis as well. So I think to the point of just working universally to try to reduce the risk of acquiring HIV, pharmacists have such a crucial role. And depending on your state and your practice, you know, that can really vary from the raising awareness aspect that we talked about before all the way to the initiation and administration, even of these injectable products that that patients may be receiving at the pharmacy. So yeah.

SPEAKER_02:

And I I think to speak to that is farm, as we know, pharmacists are probably the most accessed healthcare provider. And if we're talking about removing barriers to care, a lot of the individuals that are at risk are, as we said, late teens, 20s, may not have other healthcare-related issues, may not be established with a medical provider, may not want to go to a medical provider. Uh so it provides another option for patients. And as we I think talk about this day and age of creating options and removing barriers, pharmacists are well placed. And in and where I practice, it's uh it's you know, rural Idaho. A lot of times there are no providers in a community. And you may have these pharmacy islands that uh that they talk about where that pharmacy may be the only point of access for care for a lot of patients. So again, I think it's a good opportunity for pharmacists that are curious out there about integrating this into their practice, that it's very doable and that there are some other supportive tools. I know that you'll point a couple out, but there is the national curriculum program, typically driven by the University of Washington, but there's an HIV prevention national curriculum that is a wonderful tutorial. It's self-guided, there's self-assessment, and it's a it's a great area for pharmacists to go to get deeper education and information.

SPEAKER_01:

Absolutely. I'm glad you called that out because it is, I know for me, I having the knowledge and background on a topic is necessary for wanting to move forward with it and integrate it into my practice. So having those sorts of resources is really essential to improve that you know movement toward getting us even more involved in educating or providing PrEP to our patients. And I appreciate you calling out that resource. The other one that um was highlighted actually, so we didn't mention specifically, but Lenick Hapavir, after it was approved, CDC did come out with recommendations specifically, including it as a recommended option for PrEP. So those CDC recommendations are available, and that's a very helpful resource to review in terms of Lenic Hapavir, but also about PrEP in general and considerations with initiating it in practice. And in that CDC guidance, they highlighted the National Clinician Consultation Center or NCCC, I think is is how they refer to themselves. And they have a prep line. They also have a number of other hotlines that you can call, but they are a I haven't, David. We were chatting before the podcast. Yeah, please.

SPEAKER_02:

Yeah, it's it's a it's it's a great resource. They're they're staffed by well-seasoned veteran clinicians that can answer generally any nuanced question you have. And if they can't answer it, they will find one of their colleagues. So there's a quick 1-800 number. The the person screening the calls asks you who you are. You're a clinician, they take some of the information, they create a case, they send it to their to their staff, and then somebody gets back with you usually fairly quickly, definitely within a couple hours, and and will help walk you through what question you have. They may ask for more information, but again, very just an excellent grade A support.

SPEAKER_01:

And it's just excellent to me to know that there are experts out there who are willing and able and wanting to provide advice when you have tricky scenarios and you're not sure what to do. It's just, I find it amazing that it's a it's a free resource, as you said, they get back to you promptly. And just to have that available as another tool for pharmacists, I think is very reassuring to know that you can rely on that as well. And then, you know, I do want to just call out another potential resource that people may be interested in. I think some of you may know I also work with Pearls. Pearls is a modern and sort of next generation drug information resource and mobile app. And CE Impact and Pearls have a partnership where it really makes sense because Pearls provides sort of those drug information evidence-based resources and tools. CE Impact provides the education side of things. And so, as part of that collaboration, I just wanted to highlight one of the evidence-based tools that we have at Pearls that just ties in with CE Impact's passion for pharmacy education. So I'm actually gonna share my screen real quick here. For those of you watching the video, you'll be able to see this. But for those listening, it will be available in the show notes for the podcast and on the CE Impact website. But this is just a great example of a chart from Pearls on PrEP, and it talks through some of those eligibility considerations as well as the fact that we don't need to ask about specific risk factors if a patient comes in asking for prep. Um, it also reviews the available regimens, both oral and injectable. It walks through those baseline screening considerations as well as follow-up assessment and really all in a quick one-pager, easy-to-read format on the Pearl's website. There's also a full pharmacotherapy review on prep that walks through all of these patient care process considerations in more detail. So, just a couple more examples of some of the resources from Pearls that are designed to help care for patients in this, you know, busy pharmacy practice setting and improve efficiency. So just wanted to highlight that as well. And I think we have time maybe just to quickly reiterate a couple of key counseling points, David. So we talked about side effects, which is really helpful, obviously, something we need to be thinking about. Dragon reactions, we talked about, you mentioned early on adherence. And I think just reiterating that is such an important point, and especially thinking about the injectables that we have now, and if there are concerns around adherence with the oral forms, weighing that as a potential consideration if adherence is spotted as a concern, or if as you're discussing it with patients, that's that's coming up as a potential issue. Um, you know, I'm thinking also about HIV prep is for HIV, but you've brought up STIs quite a lot in this discussion too. And it does not prevent STIs. So safer sex with condoms and other you know strategies to reduce those risks is also a consideration. But any other key counseling points or considerations that we want to highlight before we wrap up?

SPEAKER_02:

Uh I don't think so, but just I think for completeness, as we did mention, renal impairment and the other products, this lenacapivir can be used safely down to 15 mils per minute. So you do want to make sure you do that. And it is fine in individuals with child Pew class A and B, and really hasn't been studied in C, so we don't necessarily know. And the other thing to note is that in most of these products, they the indication is based on weight, not on age. And individuals who are less than 18, and this is very different from state to state, but individuals who are less than 18 that we know are at really high risk for HIV are candidates as long as they meet a lot of the weight requirements. So I think that is, again, as you think about including this into your practice, and if you are thinking about individuals less than 18, that you make sure you understand what your state statutes and limitations are in treating individuals less than 18.

SPEAKER_01:

Yep. Yep, great call out there. And I think good to highlight that population as well as that might not come to mind immediately for some of us. So good to call that out. We do have option these options available for for younger patients as well. So to wrap up our discussion, David, it is our Game Changes Clinical Update podcast. So what would you say is the game changer that you would want our listeners to walk away with today?

SPEAKER_02:

Uh the game changer is that it's within our power to eliminate HIV. Period. And we need to utilize the tools that are that are at our disposal, both on a national level as well as on a global level. And these products, we need to level the playing field. That these products just should not be for individuals who have insurance, who have a payer source, but there needs to be involvement on a global level to be able to make these products more accessible for everybody who is at risk. And as we continue to work towards reducing stigma, shame, normalizing substance use and sexual activity, that really will continue to make those strides to end the HIV epidemic and to I think maximize the use of these medications because they're not going to work sitting on shelves. They need to get into patience, and pharmacists can help drive that.

SPEAKER_01:

Excellent. Well, thank you so much for that very uh nice summary and really uh empowering the role of pharmacists, I think, in this area. So I really appreciate your time and expertise on this topic, David. Thank you.

SPEAKER_02:

It's been a pleasure. Thank you.

SPEAKER_00:

Excellent. And that's it for this week. Be sure to log in to Healthmart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.