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

Cabotegravir is a long-acting HIV medication that comes as an injection you receive once every two months. It belongs to a class of drugs called integrase inhibitors, which work by blocking HIV from copying itself inside your cells. This medication represents a significant step forward in HIV treatment, offering people living with HIV an alternative to daily pills.

The intramuscular injection is given deep into your muscle, typically in your buttocks, by a healthcare provider in a clinical setting. You'll need to visit your doctor's office or clinic every eight weeks for your injection, making it a convenient option for people who prefer not to take daily medications.

What is Cabotegravir Used For?

Cabotegravir injection is used to treat HIV infection in adults and adolescents who weigh at least 35 kilograms (about 77 pounds). It's designed for people whose HIV is already well-controlled with other medications and who want to switch to a long-acting treatment option.

You can't start cabotegravir injections right away if you're newly diagnosed with HIV. Your doctor will first make sure your HIV viral load is undetectable using other HIV medications, usually for at least three months. This ensures that cabotegravir will be effective for you.

The injection is always given together with rilpivirine, another long-acting HIV medication. This combination therapy helps prevent HIV from developing resistance to either drug, keeping your treatment effective over time.

How Does Cabotegravir Work?

Cabotegravir works by blocking an enzyme called integrase that HIV needs to reproduce inside your cells. Think of integrase as a key that HIV uses to insert its genetic material into your healthy cells. By blocking this key, cabotegravir prevents HIV from making copies of itself.

This medication is considered a potent and effective HIV drug. When combined with rilpivirine, it creates a strong barrier against HIV replication. The long-acting formulation means the medication stays in your system for weeks, providing continuous protection against HIV.

Because cabotegravir is released slowly from the injection site, it maintains therapeutic levels in your blood for about two months. This sustained release is what makes the every-eight-week dosing schedule possible.

How Should I Take Cabotegravir?

Cabotegravir is given as an intramuscular injection by your healthcare provider, so you don't need to worry about taking it yourself. The injection is administered deep into the muscle of your buttocks, alternating between the left and right side with each visit.

Before starting the long-acting injections, your doctor will likely have you take oral cabotegravir and rilpivirine tablets for about a month. This oral lead-in period helps ensure you tolerate the medications well before committing to the injectable form.

You don't need to fast or eat specific foods before receiving your injection. However, you should arrive at your appointment well-hydrated and comfortable. The injection itself takes just a few minutes, though you may need to wait in the clinic for a short observation period afterward.

Your healthcare provider will schedule your injections every eight weeks, and it's important to keep these appointments. Missing or delaying injections can lead to decreased medication levels and potential treatment failure.

How Long Should I Take Cabotegravir For?

Cabotegravir is a long-term treatment for HIV, which means you'll likely continue receiving injections for years or potentially for life. HIV treatment is typically lifelong because stopping effective HIV medications allows the virus to multiply again, even if it was previously undetectable.

Your doctor will monitor your progress with regular blood tests to check your viral load and CD4 cell count. As long as the medication continues to keep your HIV suppressed and you're tolerating it well, you'll continue with the every-eight-week injection schedule.

If you need to stop cabotegravir injections for any reason, your doctor won't simply discontinue them abruptly. Instead, they'll transition you to daily oral HIV medications to ensure continuous treatment and prevent your HIV from becoming resistant to medications.

What Are the Side Effects of Cabotegravir?

Like all medications, cabotegravir can cause side effects, though not everyone experiences them. The most common side effects are generally mild and tend to improve as your body adjusts to the medication.

Here are the most frequently reported side effects you might experience:

• Injection site reactions like pain, swelling, or redness
• Headache
• Fever
• Fatigue or tiredness
• Muscle aches
• Nausea
• Sleep problems or unusual dreams
• Dizziness

The injection site reactions are usually the most noticeable side effect. You might feel soreness, see some swelling, or notice a small lump at the injection site. These reactions typically resolve within a few days and tend to become less bothersome with subsequent injections.

While less common, some people may experience more serious side effects that require immediate medical attention:

• Severe allergic reactions with difficulty breathing or swelling of face and throat
• Severe depression or thoughts of self-harm
• Liver problems indicated by yellowing of skin or eyes
• Persistent severe injection site reactions that don't improve
• Signs of immune system changes like unusual infections

If you experience any of these serious side effects, contact your healthcare provider immediately or seek emergency medical care. Your safety is the top priority, and your medical team is there to help manage any concerns.

Who Should Not Take Cabotegravir?

Cabotegravir isn't suitable for everyone, and your doctor will carefully evaluate whether it's right for you. People with certain medical conditions or taking specific medications may not be good candidates for this treatment.

You should not receive cabotegravir injections if you have any of these conditions:

• Known allergic reactions to cabotegravir or rilpivirine
• Active hepatitis B infection (requires special monitoring)
• Severe liver disease or liver failure
• Current use of certain medications that interact dangerously with cabotegravir
• HIV that is resistant to integrase inhibitors

Your doctor will also use caution if you have a history of depression, mental health conditions, or liver problems. These conditions don't necessarily prevent you from using cabotegravir, but they require closer monitoring and may influence your treatment plan.

Pregnant women require special consideration, as the safety of cabotegravir during pregnancy is still being studied. If you're pregnant or planning to become pregnant, discuss all your options with your healthcare provider.

Cabotegravir Brand Names

Cabotegravir injection is available under the brand name Apretude when used alone for HIV prevention, and as part of Cabenuva when combined with rilpivirine for HIV treatment. The specific brand name may vary depending on your country and healthcare system.

Your pharmacy or healthcare provider will ensure you receive the correct formulation for your specific treatment needs. Both formulations contain the same active ingredient, cabotegravir, but are indicated for different uses.

Cabotegravir Alternatives

If cabotegravir injections aren't right for you, several other effective HIV treatment options are available. Your doctor can help you find an alternative that fits your lifestyle and medical needs.

Other long-acting HIV treatment options include different injectable medications or implantable devices, though these may not be widely available yet. Most people have excellent results with daily oral HIV medications, which come in various combinations.

Some popular oral HIV medication alternatives include single-tablet regimens that combine multiple HIV drugs into one daily pill. These might include combinations of drugs like efavirenz, emtricitabine, and tenofovir, or newer combinations with drugs like bictegravir.

Your choice of HIV treatment should consider factors like your lifestyle, other medical conditions, potential drug interactions, and personal preferences. What matters most is finding a treatment you can stick with long-term.

Is Cabotegravir Better Than Other HIV Medications?

Cabotegravir injections aren't necessarily "better" than other HIV medications, but they offer unique advantages that make them ideal for certain people. The main benefit is convenience – receiving an injection every eight weeks instead of taking daily pills.

Studies show that cabotegravir injections are just as effective as daily oral HIV medications at keeping HIV suppressed. In clinical trials, both injection and oral treatments achieved similar rates of viral suppression, meaning both approaches work excellently.

The choice between cabotegravir injections and other HIV medications often comes down to personal preference and lifestyle factors. Some people prefer the convenience of injections, while others prefer the control and privacy of taking daily pills at home.

Your doctor will help you weigh the pros and cons based on your specific situation, medical history, and treatment goals. The best HIV medication is the one you can take consistently and that keeps your HIV well-controlled.