Approved by the FDA in late January 2021, CAB/RPV LA (cabotegravir/rilpivirine) is considered an optimization strategy for individuals with HIV whose virus is suppressed by oral ART and who might prefer monthly injections versus daily oral therapy. While there are various reasons why patients might wish to switch to a long-acting injectable, one of the primary concerns is adherence. Of note, the guidance points to phase 3 clinical study findings that suggest high levels (86% to 91%) of patient satisfaction with CAB/RPV LA, which portends a promising future for this therapeutic approach.
With regard to patient preference, recommendations focus on the need to thoroughly discuss several critical requisites with potential candidates, including a 4-week lead-in daily oral ART course (CAB [Vocabria] 30 mg, RPV [Edurant] 25 mg) before initiating a loading dose. Patients should be advised of the potential for development of resistance should dosing be interrupted for any reason (CAB and RPV have extended half-lives ranging from mean 5.6-11.5 weeks for CAB and 13-28 weeks for RPV), as well as the need to return to oral bridging therapy if subsequent injections are not administered within the 7-day window period. If the maintenance dose is delayed beyond 2 months, a loading dose and restart is necessary.
CAB/RPV LA therapy is administered into opposing gluteal muscles (CAB into one gluteus medius and RPV into the contralateral gluteus medius) and injection-site pain beginning 1 day post-injection and lasting 3-4 days is common.
Source: Medscape