Cabotegravir/rilpivirine

• Long-acting injectable medication used to treat HIV
• Studied after viral suppression with oral CAB/RPV, but this is not likely to be necessary
• Dosing
  • Monthly: 600 mg/900 mg IM on week 1 followed by 400 mg/600 mg every 4 weeks
  • Every 2 monthly: 600 mg/900 mg IM every 4 weeks for 2 doses followed by every 8 weeks
  • Can be given ±1 week of target date
  • If they are going to miss a dose, they should get bridge oral dosing (preference for oral CAB/RPV, but can be anything)
• Injections
  • May need long needle to reach muscle in obese patients
  • Often given as rilpivirine into right buttock (R in R) and cabotegravir into left
• Virologic failures
  • Occur despite perfect adherence
  • Increased if rilpivirine RAMs, low 8-week trough levels, HIV-1 subtype A6 and A3, and with elevated BMI
• Contraindications: anticoagulation (given risk of IM bleeding), buttock implants, drug-drug interactions, and HIV-hepatitis B coinfection
  • Use with caution if risk factors for virologic failure; may warrant closer monitoring