The long-acting injectable shaping the future of HIV therapy

Cabotegravir/rilpivirine (Cabenuva®) gained approval by Health Canada, the US Food and Drug Administration, and the European Commission in 2021 as the first long-acting injectable for HIV-1 treatment in virally supressed adults. A long-acting formulation of cabotegravir (Apretude®) subsequently showed promise when trialled as an option for HIV prevention in adults and adolescents, offering an alternative to the well-established daily pre-exposure prophylaxis (PrEP) regimen. For HIV treatment, cabotegravir/rilpivirine has been approved for those aged 12 and older, although insufficient evidence currently exists to support its use in pregnancy. Cabotegravir/rilpivirine is the first long-acting injectable medication approved for HIV treatment and prophylaxis, available to virally suppressed adults and adolescent patients with no history of treatment failure. The incorporation of long-acting injectables into standard HIV care is expected to mitigate some of the non-adherence issues with daily oral HIV regimens by demanding fewer lifestyle adjustments, and by enhancing patient confidentiality through infrequent dose administrations. Despite barriers to achieving global access, long-acting injectables have the potential to dampen further transmission, and to simplify treatment options for patients who are already affected by HIV. Efforts are under way to expand the reach of cabotegravir to low- and middle-income countries to maximise the impact of long-acting injectables on reducing HIV transmission worldwide