Cabotegravir is an integrase strand transfer inhibitor that prevents HIV from integrating its genetic material into human cells. Its long acting formulation provides an alternative to taking oral medication every day in some HIV prevention and treatment settings. WHO recommends long acting injectable cabotegravir as an additional HIV prevention choice for people at substantial risk of HIV acquisition. In treatment, cabotegravir is used with rilpivirine as a long acting regimen for appropriately selected people who have already achieved viral suppression.
Long acting cabotegravir is designed to maintain therapeutic drug levels over an extended period. For HIV prevention, the injectable formulation is administered at scheduled intervals rather than requiring daily tablets. WHO guidance describes an initial injection schedule followed by injections every eight weeks.
For HIV treatment, cabotegravir is combined with rilpivirine in a long acting injectable regimen. Current WHO guidance recognizes this combination as an alternative switching option for adults and adolescents who have achieved full viral suppression with oral ART and do not have active hepatitis B infection.
Key aspects include:
Cabotegravir has two important roles in modern HIV care. As long acting PrEP, it is given to HIV negative individuals who have substantial risk of acquiring HIV. WHO recommends it as an additional prevention option alongside other established prevention approaches.
As HIV treatment, cabotegravir is combined with rilpivirine. The regimen is intended for people who meet specific clinical criteria, including sustained viral suppression and the absence of known or suspected resistance to the medicines. FDA prescribing information also specifies its use in people who are virologically suppressed and have no history of treatment failure for the indicated treatment regimen.
Important considerations include:
Long acting treatment can make medication administration less frequent, but it does not eliminate the need for regular healthcare visits. HIV testing is particularly important when cabotegravir is being used for prevention because undiagnosed HIV infection can have implications for drug resistance. WHO has highlighted HIV testing and drug resistance as important considerations in delivering long acting cabotegravir.
Healthcare monitoring may include:
Cabotegravir therefore represents an important development in long acting HIV care, but it is not appropriate for every person. Selection of prevention or treatment options depends on HIV status, treatment history, viral suppression, resistance considerations, other medical factors, and access to scheduled clinical care. WHO's updated HIV clinical management recommendations continue to emphasize optimized antiretroviral therapy and person-centred HIV services.
For informational purposes, cabotegravir demonstrates how HIV care is expanding beyond daily oral medication toward longer acting approaches. Its use in both prevention and selected treatment settings provides additional choices while maintaining the importance of HIV testing, clinical monitoring, adherence to injection schedules, and appropriate medical assessment.