Long acting cabotegravir, commonly called CAB LA, is an injectable antiretroviral medicine used for HIV pre exposure prophylaxis, or PrEP. PrEP is intended for people who are HIV negative and may have a substantial risk of acquiring HIV. Cabotegravir belongs to the integrase inhibitor class of antiretroviral medicines. WHO recommends CAB LA as an additional HIV prevention choice within comprehensive prevention approaches.
Cabotegravir works by inhibiting HIV integrase, an enzyme HIV needs to integrate its genetic material into human cells. For PrEP, the medicine is administered by intramuscular injection and remains in the body for an extended period. WHO describes an initial injection schedule followed by injections approximately every eight weeks.
Research into CAB LA has focused on several important areas:
The longer dosing interval is an important area of research because it may provide an alternative for people who experience challenges with taking an oral PrEP tablet every day. It also creates a need for reliable clinic appointments and appropriate HIV testing.
Two major randomized controlled trials, HPTN 083 and HPTN 084, provided important evidence about CAB LA. HPTN 083 studied HIV negative cisgender men who have sex with men and transgender women who have sex with men. The study compared injectable cabotegravir with daily oral TDF FTC PrEP and found fewer HIV infections in the cabotegravir group.
HPTN 084 evaluated CAB LA among cisgender women in several sub Saharan African countries. The trial included 3,223 women and compared injectable cabotegravir with daily oral TDF FTC. The study reported substantially fewer HIV infections among participants receiving cabotegravir.
Research has highlighted several considerations:
One important research issue is the pharmacokinetic tail. Because cabotegravir remains in the body for an extended period after administration stops, low concentrations can persist for months. If a person acquires HIV during this period, researchers have considered whether insufficient drug concentrations could contribute to resistance. WHO has identified HIV testing and drug resistance as important areas for continued monitoring and research.
Research has also examined pregnancy and breastfeeding. WHO identifies safety during pregnancy and breastfeeding as areas requiring continued evidence collection. Open label research has included studies examining cabotegravir exposure and safety among women who become pregnant while participating in research.
As HIV prevention develops, CAB LA is being considered alongside other PrEP choices rather than as a replacement for every existing method. WHO currently lists oral PrEP, the dapivirine vaginal ring and long acting injectable cabotegravir among HIV prevention options, while newer long acting approaches such as injectable lenacapavir have also expanded the prevention landscape.
Long acting cabotegravir represents an important area of HIV prevention research because it provides a prevention approach that does not require daily oral dosing. Evidence from major clinical trials has demonstrated high effectiveness, while ongoing research continues to examine HIV testing, resistance, pregnancy, acceptability, access and real world implementation. CAB LA is therefore best understood as one component of comprehensive HIV prevention, with the appropriate prevention approach depending on individual circumstances and healthcare guidance.