What the CLARITY Study Means for Counseling on Long-Acting HIV PrEP

"What the CLARITY Study Means for Counseling on Long-Acting HIV PrEP" puts a recent preference study under the microscope and asks what it should, and should not, change in practice.

Dr. Cocohoba introduces the CLARITY study, released this year. In this open-label crossover study, people without HIV received a single cabotegravir injection and a lenacapavir dose, given as two injections, in alternating order. Participants appeared to prefer cabotegravir. She asks how the findings influence Dr. Urbina's practice.

Dr. Urbina says the results did not surprise him. Because lenacapavir is given subcutaneously, a nodule is expected, while an intramuscular injection can remain hidden. Those differences shaped how participants rated their injection site reactions. However, he stresses that CLARITY was a single study and not a head-to-head efficacy comparison. It also captured only one injection of each agent, so it says little about later doses. In his experience, both the frequency and intensity of lenacapavir reactions decrease with subsequent injections. He would like to see longer-term data.

He adds that patients in real practice weigh a different tradeoff. Many accept more injection site reactions early on in exchange for coming in only twice a year rather than every 2 months. For Dr. Urbina, the study is most useful as a counseling tool. It helps him explain how the two products differ, but it has not led him to favor one over the other.

Dr. Cocohoba agrees that the data were useful. She says the study helped her think more concretely about how to prepare patients for what to expect from each injection. She notes that first injections tend to carry higher reports of pain, because patients do not yet know what to expect. For that reason, she believes data across multiple injections would have been more meaningful. She also points out that clinicians now administer lenacapavir in the thigh as well as the abdomen. Learning whether injection site changed preferences would have offered a more complete picture of the patient experience.

Up next, in "HIV PrEP Stigma and the Acceptability of Long-Acting Options," the experts discuss how stigma still shapes PrEP decisions and what early evidence shows about whether communities will embrace long-acting options.