Long-Acting Cabotegravir Plus Rilpivirine in People With HIV With Adherence Challenges and Viremia: Current Data and...

Long-acting injectable cabotegravir plus rilpivirine (LA CAB/RPV) is currently US Food and Drug Administration approved and Human Immunodeficiency Virus (HIV) treatment guideline endorsed as a switch strategy for patients with HIV (PWH) who are virologically suppressed on oral antiretroviral therapy without a history of treatment failure. Recent changes to the International Antiviral Society-USA and US Department of Health and Human Services' Panel on Antiretroviral Guidelines recommend the consideration of LA CAB/RPV in select PWH with viremia who are unable to achieve suppression with oral antiretroviral therapy due to suboptimal medication adherence. In this article, we review the existing data on this off-label use of LA CAB/RPV, discuss the motivations and specific caveats implicit in the guideline change, and propose next steps in exploring this novel treatment in a vulnerable patient population.