Comparing carbon emissions from oral tenofovir disoproxil fumarate/emtricitabine for preexposure prophylaxis and long-acting injectables for HIV prevention.

Estimated greenhouse gas emissions from active pharmaceutical ingredient (API) production were compared for oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and long-acting injectable preexposure prophylaxis (PrEP) agents, cabotegravir (CAB-LA) and lenacapavir (LEN). For 2 million person-years of PrEP, TDF/FTC generated approximately 108 million kg CO2e, compared with 4.1 million kg for CAB-LA and less than 0.1 million kg for LEN. These findings suggest substantially lower emissions with long-acting agents, supporting consideration of environmental sustainability in HIV prevention strategies.