What is Cabotegravir and Rilpivirine: Uses, Dosage, Side Effects and More

Cabotegravir and rilpivirine is a combination HIV medication given as a monthly or every-other-month injection. This treatment represents a significant breakthrough for people living with HIV who want freedom from daily pills while maintaining excellent control of their virus.

The injection combines two powerful HIV medicines into one shot that you receive at your healthcare provider's office. Many people find this approach much more convenient than remembering daily medications, and it can provide the same excellent viral suppression as traditional pill-based treatments.

What is Cabotegravir and Rilpivirine?

Cabotegravir and rilpivirine is a long-acting injectable combination of two HIV medications that work together to suppress the virus. Cabotegravir belongs to a class called integrase inhibitors, while rilpivirine is a non-nucleoside reverse transcriptase inhibitor.

This medication comes as two separate injections given in your buttocks muscles during the same visit. The medicine stays in your system for weeks, slowly releasing the active ingredients to keep your HIV under control without daily pills.

Your doctor will typically start you on oral versions of these same medications for about a month first. This helps ensure your body tolerates the medicines well before switching to the long-acting injections.

What is Cabotegravir and Rilpivirine Used For?

This injectable combination treats HIV-1 infection in adults who already have an undetectable viral load. You need to have achieved viral suppression with other HIV medications first before switching to these injections.

The treatment works best for people who have never had treatment failure with either integrase inhibitors or rilpivirine-type medications. Your doctor will review your treatment history to make sure this option is right for your specific situation.

Many people choose this treatment because it eliminates the need for daily pills while maintaining excellent HIV control. It's particularly helpful if you struggle with pill burden, have difficulty remembering daily medications, or simply prefer fewer medical reminders in your daily life.

How Does Cabotegravir and Rilpivirine Work?

This combination medication works by blocking HIV at two different stages of its reproduction cycle. Cabotegravir prevents the virus from integrating its genetic material into your healthy cells, while rilpivirine stops the virus from making copies of itself.

Both medicines are considered potent HIV medications that provide strong viral suppression. The long-acting formulation means the medicines stay active in your system for weeks after each injection, maintaining consistent levels to keep the virus controlled.

The dual approach makes it very difficult for HIV to develop resistance, since the virus would need to overcome two different blocking mechanisms simultaneously. This makes the combination both effective and durable for long-term HIV treatment.

How Should I Take Cabotegravir and Rilpivirine?

You'll receive these injections at your healthcare provider's office, never at home. The treatment involves two separate shots given in your buttocks muscles during the same appointment.

Before starting injections, you'll typically take oral versions of both medications for about four weeks. This oral lead-in period helps your doctor confirm you tolerate the medicines well and achieve good blood levels before switching to the long-acting form.

During your injection visit, you'll receive one shot of cabotegravir and one shot of rilpivirine in different areas of your buttocks. The injection process takes just a few minutes, though you may need to stay for a brief observation period afterward.

No special preparation is needed before your injection appointment. You can eat normally and don't need to take any pills on injection days once you've completed the oral lead-in period.

How Long Should I Take Cabotegravir and Rilpivirine For?

You'll continue these injections for as long as they're effectively controlling your HIV and you're tolerating them well. Most people stay on this treatment long-term, just like any other HIV medication regimen.

Your doctor will monitor your viral load regularly to ensure the treatment continues working effectively. As long as your virus remains undetectable and you're not experiencing problematic side effects, you can continue with the injections indefinitely.

If you decide to stop the injections for any reason, your doctor will help you transition back to daily oral HIV medications. This transition needs to be carefully planned to avoid any gaps in your HIV treatment that could allow the virus to rebound.

What Are the Side Effects of Cabotegravir and Rilpivirine?

Most people tolerate these injections well, but you might experience some side effects, especially in the first few months. The most common issues relate to the injection site and some general body symptoms.

Here are the side effects you're most likely to encounter as your body adjusts to this treatment:

• Pain, swelling, or tenderness at injection sites
• Headache and fatigue
• Muscle aches and joint pain
• Nausea or stomach discomfort
• Dizziness or trouble sleeping
• Fever or flu-like symptoms

These common side effects usually improve significantly after the first few injection cycles as your body adapts to the medication routine.

Some people may experience more significant side effects that require medical attention. While these are less common, it's important to know what to watch for so you can get help if needed.

Contact your healthcare provider if you experience any of these more serious concerns:

• Severe injection site reactions with excessive swelling, hardness, or infection signs
• Persistent mood changes, depression, or suicidal thoughts
• Severe skin reactions or rashes
• Signs of liver problems like yellowing skin or eyes
• Unusual muscle weakness or pain
• Severe allergic reactions with trouble breathing

While rare, some people may develop post-injection reactions that can occur within minutes to hours after receiving the shots. These reactions are uncommon but require immediate medical attention if they involve difficulty breathing or severe whole-body symptoms.

Who Should Not Take Cabotegravir and Rilpivirine?

This injection combination isn't suitable for everyone with HIV. Your doctor will carefully review your medical history and current health status to determine if this treatment is safe for you.

You should not receive these injections if you have certain medical conditions or take specific medications that could interact dangerously with the treatment.

Here are the main situations where this treatment typically isn't recommended:

• Previous allergic reactions to cabotegravir or rilpivirine
• Current hepatitis B infection (requires special consideration)
• Taking certain medications that significantly interact with these drugs
• History of treatment failure with integrase inhibitors or rilpivirine-type drugs
• Severe liver disease or significantly elevated liver enzymes
• Pregnancy or planning to become pregnant

Your doctor will also consider whether you're taking other medications that could interfere with these injections, including some antacids, seizure medications, or certain antibiotics.

Some people with kidney problems, mental health conditions, or other medical issues may need extra monitoring or different treatment approaches. Your healthcare team will work with you to determine the safest and most effective HIV treatment plan for your specific situation.

Cabotegravir and Rilpivirine Brand Names

The brand name for this injectable combination is Cabenuva. This is the only formulation currently available that combines both medications into a long-acting injection system.

Cabenuva is manufactured by ViiV Healthcare and was specifically designed as a monthly or every-other-month injection alternative to daily HIV pills. The brand name is the same regardless of whether you receive monthly or every-other-month dosing.

Your pharmacy and insurance may refer to this medication by either its brand name (Cabenuva) or by the individual drug names (cabotegravir and rilpivirine extended-release injectable suspension).

Cabotegravir and Rilpivirine Alternatives

Several other HIV treatment options are available if injectable therapy isn't right for you. Your doctor can help you choose the best alternative based on your specific needs, medical history, and preferences.

Daily oral HIV medications remain the most common treatment approach and work excellently for most people. These might include combinations like bictegravir/tenofovir alafenamide/emtricitabine or dolutegravir plus other drugs.

Other long-acting options are being developed, including different injectable combinations and even longer-acting formulations. Your healthcare provider can discuss what treatments might become available in the future if current options don't meet your needs.

Some people benefit from switching between different HIV treatment approaches over time as their life circumstances change. The most important thing is maintaining consistent, effective viral suppression with whatever treatment works best for your situation.

Is Cabotegravir and Rilpivirine Better Than Other HIV Medications?

This injectable combination isn't necessarily "better" than other HIV treatments, but it offers unique advantages that make it ideal for certain people. The main benefit is convenience - no daily pills to remember while maintaining excellent viral control.

Clinical studies show that Cabenuva is just as effective as daily oral HIV medications at keeping viral loads undetectable. The success rates are comparable, with most people maintaining viral suppression as long as they continue with their scheduled injections.

The choice between injectable and oral treatments often comes down to personal preference and lifestyle factors. Some people prefer the freedom from daily pills, while others prefer the control and flexibility of taking medication at home.

Your doctor will help you weigh the benefits and potential drawbacks based on your specific situation, treatment history, and personal preferences. The "best" HIV treatment is always the one that you can stick with consistently and that keeps your virus undetectable.