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A long-acting injectable to prevent HIV infection may be generating hope that a new era in the battle against AIDS is about to begin. But a newly published analysis suggested the medicine will not be cost-effective unless the price is considerably lower, since much cheaper pills to prevent HIV are available.

At issue is Apretude, which was approved late last year by U.S. regulators as the first alternative to a pill — known as pre-exposure prophylaxis, or PrEP— that must be taken daily to prevent HIV. The brand and generic versions of the pill are 99% effective, but only when taken as prescribed. That has proven problematic because not everyone adheres to the regimen, and studies have found discontinuation rates are high and persist over time.

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