Cabotegravir/rilpivirine in pregnancy: early insights from clinical practice

To describe early experience with the use of cabotegravir/rilpivirine (CAB/RPV) in pregnancy and make recommendations based on these observations.

This is a case series.

This took place at a multidisciplinary HIV clinic based at an academic centre in Ottawa, Canada.

Women who received CAB/RPV during pregnancy and carried their child through to delivery are described.

The first seven such women were enrolled and their clinical course is described.

The primary outcome was a description of the experience and clinical effectiveness of CAB/RPV when used through pregnancy.

Initially, CAB/RPV was discontinued after pregnancy was confirmed and oral antiretroviral therapy was initiated instead. With evolving information on the safety and pharmacokinetics of cabotegravir and rilpivirine and advancing clinical experience, CAB/RPV given every 2 months was continued through pregnancy and oral antiretroviral therapy was added at 34-36 weeks gestation up until delivery to address the potential for subtherapeutic levels of cabotegravir and/or rilpivirine. In one individual where oral therapy was not an option, CAB/RPV was administered monthly from 20 weeks' gestation. All women maintained an undetectable viral load at the time of delivery.

With the challenges and potential risks associated with interrupting CAB/RPV before or during pregnancy, we have established an approach to address this. Maintaining CAB/RPV q monthly or supplementing CAB/RPV q2 months with oral therapy starting at 34-36 weeks' gestation until delivery are potential approaches that allow CAB/RPV to be administered uninterrupted during pregnancy.