Cabotegravir is an antiretroviral medicine that belongs to the integrase strand transfer inhibitor class. It works by interfering with HIV integrase, an enzyme HIV needs to insert its genetic material into human cells. Long acting formulations allow medicine to remain active in the body for longer periods than conventional daily oral medicines.
For HIV treatment, long acting cabotegravir is used together with rilpivirine in appropriately selected people whose HIV is already controlled. Cabotegravir is also available as a long acting injectable form for HIV prevention, known as pre exposure prophylaxis or PrEP. The specific formulation, schedule and eligibility requirements depend on its intended use.
Cabotegravir can be provided as an oral formulation or as an extended release injection. The injectable form is administered by a healthcare professional rather than taken independently at home. This approach can reduce the frequency of medication administration compared with daily oral therapy.
For treatment, cabotegravir is combined with rilpivirine as a long acting regimen. For PrEP, injectable cabotegravir is used to reduce the risk of acquiring HIV in people who are HIV negative and at risk of HIV infection.
Important considerations include:
Research into cabotegravir has examined both HIV prevention and treatment. Studies have investigated whether less frequent injections can maintain effective drug concentrations and viral suppression while addressing some of the challenges associated with daily medication.
The CARES trial examined long acting cabotegravir and rilpivirine among adults in Uganda, Kenya and South Africa who already had suppressed HIV viral loads. At 96 weeks, 97 percent of participants in both the long acting and oral therapy groups had viral loads below 50 copies per milliliter, supporting noninferior viral suppression in the studied population.
Research areas include:
Research has also identified the importance of managing missed injections and monitoring for HIV infection because prolonged exposure to low drug concentrations after stopping treatment may have implications for resistance.
Like other prescription medicines, cabotegravir can cause adverse effects. Injection site reactions are among the commonly reported effects associated with injectable formulations. Healthcare professionals also consider possible hypersensitivity reactions and liver-related problems when monitoring people receiving cabotegravir.
People receiving cabotegravir should discuss their medical history and other medicines with their healthcare professional. Regular HIV testing is particularly important when cabotegravir is being used for prevention because PrEP should not be continued as though a person remains HIV negative when an HIV infection has developed.
Long acting HIV medicines are an expanding area of research. Current studies are examining how injectable therapies can be incorporated into different healthcare systems while maintaining appropriate testing, follow-up and resistance monitoring.
cabotegravir represents an important development in long acting HIV medicine. Its use in combination with rilpivirine provides a long acting treatment option for appropriately selected people with HIV, while injectable cabotegravir is also used for HIV PrEP. Ongoing research continues to examine effectiveness, safety, adherence, resistance, accessibility and practical implementation. Medical decisions about cabotegravir should be made with a qualified healthcare professional based on the individual's HIV status, treatment history and clinical circumstances.