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cabotegravir/rilpivirine (Cabenuva)

Indications: - treatment of HIV1 infection - inability to take oral antiretroviral therapy [4] - high risk for HIV1 disease progression - CD4 count < 200/uL or history of AIDS-defining illness [4] - access to intensive clinical follow-up & case management [4] Contraindications: - coinfection with hepatitis B [3] Dosage: - month 1: start cabotegravir 30 mg plus rilpivirine 25 mg to assess tolerability - month 2: 2 IM injections cabotegravir 600 mg/3mL plus rilpivirine 900 mg/3mL - month 3: 2 IM injections cabotegravir 600 mg/3mL plus rilpivirine 900 mg/3mL - month 5: 2 IM injections cabotegravir 600 mg/3mL plus rilpivirine 900 mg/3mL - month 7: 2 IM injections cabotegravir 600 mg/3mL plus rilpivirine 900 mg/3mL - continue same 2 IM injections every 2 months * long-acting cabotegravir 200 mg/mL (600 mg) plus rilpivirine 300 mg/ml (900 mg) every 8 weeks (2 injections) IM [1,2] Durg interactions: - anticonvulsants carbamazepine, oxcarbazine, phenobarbital & phenytoin decrease plasma levels of cabotegravir & rilpivirine - antimicobials rifampin, rifapentine, rifabutin decrease plasma levels of cabotegravir & rilpivirine - dexamethasone decreases plasma levels of rilpivirine - St John's wort decreases plasma levels of rilpivirine - macrolides increase plasma levels of rilpivirine (risk or QT prolongation & torsades de pointes)

General

antiretroviral combination

References

  1. Margolis DA, Gonzalez-Garcia J, Stellbrink HJ et al Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet. July 24, 2017 PMID: 28750935 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31917-7/fulltext - Boyd MA, Cooper DA Long-acting injectable ART: next revolution in HIV? Lancet. July 24, 2017 PMID: 28750936 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31962-1/fulltext - FDA News Release. Jan 21, 2021 FDA Approves First Extended-Release, Injectable Drug Regimen for Adults Living with HIV. https://www.fda.gov/news-events/press-announcements/fda-approves-first-extended-release-injectable-drug-regimen-adults-living-hiv
  2. Saag MS, Gandhi RT, Hoy JF, et al Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults. 2020 Recommendations of the International Antiviral Society-USA Panel. JAMA. Published online October 14, 2020 PMID: 33052386 https://jamanetwork.com/journals/jama/fullarticle/2771873
  3. Gandhi RT, Bedimo R, Hoy JF et al Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults. 2022 Recommendations of the International Antiviral Society - USA Panel. JAMA. Published online December 1, 2022. PMID: 36454551 https://jamanetwork.com/journals/jama/fullarticle/2799240
  4. Sax PE et al. Updated treatment recommendation on use of cabotegravir and rilpivirine for people with HIV from the IAS-USA Guidelines Panel. JAMA 2024 Mar 1; [e-pub] PMID: 38427337 https://jamanetwork.com/journals/jama/fullarticle/2816037
  5. Cabenuva. extended release injectable suspensions https://cabenuvahcp.com/dosing/every-2-month/
  6. Highlights of Prescribing Information CABENUVA (cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension), co-packaged for intramuscular use. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Cabenuva/pdf/CABENUVA-PI-PIL-IFU2-IFU3.PDF

Components

cabotegravir (Apretude) rilpivirine (Edurant, RPV)