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Over the past decade, there has been an increase in the number of effective, convenient, and tolerable combination antiretroviral therapy (cART) regimens for the treatment of human immunodeficiency virus (HIV). This market expansion has changed the landscape for both treatment and prevention of HIV. Before long-acting injectable (LAI) approval, a multicenter survey assessing the preferences of persons living with HIV (PLWHIV) reported the greatest interest in switching to a weekly oral regimen, followed by every 2-month injection and twice-annual implants.1 In the current era, long-acting antiretrovirals (LA ARVs) are accessible in many markets, although challenges exist with drug acquisition and process implementation. Provider pursuit of LAI agents has been more cautious, and, therefore, uptake and implementation have been gradual at best.2

Cabotegravir/rilpivirine (CAB/RPV) LAI was approved in January 2021 as the first LAI treatment regimen comprising an integrase strand transfer inhibitor (INSTI) and a non-nucleoside reverse transcriptase inhibitor (NNRTI). CAB/RPV LAI is indicated as switch therapy for PLWHIV who have been virologically suppressed and clinically stable on their current cART with no known or suspected resistance to either CAB or RPV. The package labeling recommends 2 intramuscular gluteal injections (on opposite sides or 2 cm apart) during the same visit. The ventrogluteal site is recommended, and a longer needle length (not included in the dosing kit) may be required for patients with higher body mass index (BMI), such as those with a BMI of 30 kg/m2 or higher. While no dosage changes are required for those with higher BMIs, administration utilizing a longer needle helps ensure that injections are intramuscular instead of subcutaneous. These injections are to be given by healthcare professionals every 4 to 8 weeks.3-6

Issue Section:
Frontline Pharmacist
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