Injectable Antiretrovirals: A significant advance in HIV treatment

Long-acting injectable antiretrovirals: a significant advance in HIV treatment

Cabotegravir and rilpivirine, combined in a long-acting injectable formulation (commercialized under the name Cabenuva®), represent the first complete, tablet-free treatment for people living with HIV approved in Canada. This innovative treatment allows for a departure from the traditional model based on daily pill-taking, which can represent a psychological burden for many patients.

Mechanism of action

The two active ingredients, cabotegravir and rilpivirine, work in a complementary way to prevent the virus from reproducing in the body. Administered by intramuscular injection, they maintain an effective concentration in the blood for several weeks, allowing for HIV control with only six injections per year, after an induction phase.

Administration

After an initial 28-day oral phase (called a "lead-in") to ensure good tolerance, the treatment switches to injectable mode. Two injections into the gluteal muscles are administered once a month for two months. Subsequently, the injections can be spaced out to every two months, depending on the clinical evaluation.

Why do some people choose long-acting injectable treatment?

This treatment is not necessarily for everyone, but it can represent a real life change for many:

• Fewer daily reminders: Not having to take a medication every day can free up mental load, especially when the routine becomes burdensome or a source of anxiety.
• More discretion: Without pills to carry or leave in the bathroom, some people feel freer and less exposed to indiscreet questions or stigma.
• Less risk of forgetting: For those with atypical schedules, who travel often, or who simply have difficulty maintaining a stable routine, the injectable model may be more suitable.
• A better overall quality of life: Several studies have shown that people switching to long-acting injectables report increased satisfaction, particularly due to a sense of autonomy and control over their treatment.

Efficacy

Clinical trials have shown that this treatment is as effective as daily oral regimens in maintaining an undetectable viral load. For people who are already undetectable on treatment, switching to a long-acting injectable treatment does not compromise their therapeutic success—as long as the conditions are well evaluated and respected.

Contraindications and side effects

Long-acting injectable treatment is not suitable for all people living with HIV. Some infections may have virological mutations or resistance that could reduce the effectiveness of cabotegravir or rilpivirine. Before accessing it, a complete evaluation of your file is necessary, including your viral load results, your previous treatments, and resistance tests if available.

Your HIV treatment should not have a negative impact on your quality of life. If taking daily pills becomes burdensome, or if you are simply curious to know if an alternative exists, our team can support you. We can:

• discuss your options together,
• help you prepare for the conversation with your treating physician,
• or, if you wish, contact your doctor directly to assess the relevance of this option in your case.

The most frequently reported side effects with this treatment include temporary pain at the injection site, fatigue, or headaches. These effects are generally transient and well-tolerated.

Supported care offered at our pharmacy

Your HIV treatment shouldn't have a negative impact on your quality of life. If taking daily pills has become a burden, or if you're simply curious about whether an alternative exists, our team can support you. We can:

• talk through your options together,
• help equip you to start the conversation with your treating physician,
• point you to the next steps if you'd like to explore this option.

This article aims to offer general information on long-acting injectable antiretrovirals. It does not replace personalized medical advice. Do not hesitate to consult one of our pharmacists or your doctor for any decision related to your treatment.