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Review
. 2022 Jan 1;17(1):22-31.
doi: 10.1097/COH.0000000000000708.

A new paradigm for antiretroviral delivery: long-acting cabotegravir and rilpivirine for the treatment and prevention of HIV

Sara H Bares  1 , Kimberly K Scarsi  1   2
Affiliations
Review

A new paradigm for antiretroviral delivery: long-acting cabotegravir and rilpivirine for the treatment and prevention of HIV

Sara H Bares et al. Curr Opin HIV AIDS. .

Abstract

Purpose of review: Cabotegravir (CAB) and rilpivirine (RPV) is the first long-acting injectable antiretroviral therapy (ART) option approved for virologically suppressed adults with HIV-1. In addition, long-acting CAB is a promising agent for HIV preexposure prophylaxis (PrEP). This review focuses on phase 3 clinical trial results and implementation considerations for these long-acting ART and PrEP strategies.

Recent findings: Long-acting CAB and RPV administered every 4 weeks demonstrated noninferiority to oral ART through week 96 in both the ATLAS and FLAIR studies, whereas ATLAS-2M found similar efficacy through 96 weeks when the long-acting injectable ART was administered every 8 weeks instead of every 4 weeks. For prevention, two phase 3 trials were stopped early due to fewer incident HIV infections in participants receiving long-acting CAB every 8 weeks compared with daily oral tenofovir disoproxil fumarate-emtricitabine for PrEP. The long-acting therapies were well tolerated across all clinical trials.

Summary: Clinical trial results support the use of long-acting CAB for HIV PrEP and long-acting CAB and RPV as a switch strategy for adults with HIV-1 who are first virologically suppressed with oral ART. Implementation challenges persist, and data are urgently needed in populations who may benefit most from long-acting therapy, including adolescents, pregnant individuals, and those with barriers to medication adherence.

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Conflict of interest statement

S.H.B. has served as a scientific advisor for Gilead and has received institutional research grants from Gilead, Janssen and ViiV. K.K.S. has received investigator-initiated grant support paid to her institution from Organon, LLC.

Figures

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References

    1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Available at: https://clinicalinfo.hiv.gov/sites/default/files/inline-files/AdultandAd.... [Accessed 7 October 2021].
    1. Scarsi KK, Swindells S. The promise of improved adherence with long-acting antiretroviral therapy: what are the data? J Int Assoc Provid AIDS Care 2021; 20:23259582211009011. - PMC - PubMed

    2. This is a recent review of patient satisfaction, potential adherence benefits, as well as challenges related to long-acting therapy.

    1. Delany-Moretlwe S, Mullick S, Eakle R, Rees H. Planning for HIV preexposure prophylaxis introduction: lessons learned from contraception. Curr Opin HIV AIDS 2016; 11:87–93. - PubMed
    1. Viiv Healthcare ULC. Cabenuva® and Vocabria® [product monograph]. Laval, Quebec: Viiv Healthcare ULC; 2020.
    1. Viiv Healthcare. Cabenuva® prescribing information. Research Triangle Park, NC: Viiv Healthcare; 2021.

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