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The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation
Kathrine Meyers1, Nadia Nguyen2, Jason E Zucker3
1Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 W. 168th Street, HHSC 1102, 10032, New York, NY, USA. kam2157@cumc.columbia.edu.
Abstract:
The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug "tail" that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.
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