Long acting injectable HIV treatment offers an alternative to taking oral medication every day for eligible people living with HIV. These treatments use medicines administered by healthcare professionals at scheduled intervals to help maintain viral suppression. Eligibility depends on factors such as viral load, treatment history, drug resistance, other medical conditions, and the ability to attend regular appointments.
Long acting injectable HIV treatment uses antiretroviral medicines that remain active in the body for an extended period. Unlike daily oral therapy, certain injectable regimens are administered monthly or every two months. These treatments help control HIV by preventing the virus from multiplying and maintaining viral suppression.
One established option is cabotegravir and rilpivirine, marketed together as Cabenuva in some countries. Cabotegravir is an integrase strand transfer inhibitor, while rilpivirine is a non-nucleoside reverse transcriptase inhibitor. Together, they target different stages of the HIV life cycle.
Before starting injections, healthcare professionals assess whether the treatment is appropriate for the individual. Some patients may take oral versions of the medicines before beginning injections, depending on the regimen and local prescribing guidance. However, an oral lead-in period is not always required.
Common considerations when evaluating injectable HIV treatment include:
Treatment schedule: Cabotegravir and rilpivirine injections are generally administered monthly or every two months, depending on the prescribed regimen.
Viral suppression: Candidates generally need to have HIV under control with an undetectable or suppressed viral load before switching.
Drug resistance: Resistance to either medicine can make the combination unsuitable.
Medical history: Other medications, previous treatment failures, and certain medical conditions can affect eligibility.
Follow up requirements: Patients must attend scheduled appointments to maintain effective medicine levels.
Another long acting injectable medicine, lenacapavir, is used with other antiretroviral medicines for certain people with multidrug-resistant HIV in specific treatment settings. Its eligibility requirements and accompanying treatment regimen differ from those for cabotegravir and rilpivirine. Availability and approved indications vary by country.
Eligibility for long acting injectable HIV treatment depends on the specific medicines, local approvals, and individual clinical circumstances. For cabotegravir and rilpivirine, treatment guidelines generally recommend the combination for adults and certain adolescents who meet the relevant criteria and have achieved viral suppression on a stable antiretroviral regimen.
People considering injectable therapy should discuss the following factors with their healthcare provider:
Stable viral suppression: The HIV viral load should generally be suppressed before switching to cabotegravir and rilpivirine.
Absence of relevant resistance: Previous resistance testing and treatment history help determine whether both medicines are likely to remain effective.
Hepatitis B status: Cabotegravir and rilpivirine alone do not provide adequate treatment for hepatitis B. People with HIV and hepatitis B may need to continue separate medicines active against hepatitis B.
Medication interactions: Certain medicines, including some enzyme-inducing drugs, can reduce the effectiveness of injectable treatment.
Appointment reliability: Delayed or missed injections may increase the risk of viral rebound and drug resistance. A healthcare provider can explain plans for managing delayed doses.
Side effects and monitoring: Injection-site pain, swelling, or redness may occur. Other side effects and potential risks should be reviewed before treatment begins.
Long acting injectable therapy does not cure HIV, and it does not eliminate the need for ongoing medical care. Patients should not stop or change their existing antiretroviral medicines without professional guidance. If injections are unsuitable, daily oral antiretroviral therapy remains an effective treatment option for many people.
A healthcare professional can review viral load results, resistance information, other medications, and personal circumstances to determine whether an injectable regimen is appropriate. Regular monitoring helps confirm that treatment continues to control HIV effectively.