{"id":10732,"date":"2023-06-30T13:33:07","date_gmt":"2023-06-30T17:33:07","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10732"},"modified":"2023-07-01T08:03:08","modified_gmt":"2023-07-01T12:03:08","slug":"the-yin-and-the-yang-of-cabotegravir-rilpivirine-part-one-the-good-news","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-yin-and-the-yang-of-cabotegravir-rilpivirine-part-one-the-good-news\/2023\/06\/30\/","title":{"rendered":"The Yin and the Yang of Cabotegravir-Rilpivirine: Part One, the Good News"},"content":{"rendered":"
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British advertisement, 1950.<\/p><\/div>\n

Long-acting cabotegravir-rilpivirine (CAB-RPV) is the biggest advance in HIV therapeutics in years. It’s also creating quite the challenge for ID and HIV clinicians, which makes its availability a fascinating example of the importance of education, patient communication, and shared decision-making.<\/p>\n

This post will be the good news about this groundbreaking treatment; in the next post, I’ll give the other side of the story.<\/p>\n

For those of you who don’t do HIV treatment on a regular basis, here’s a brief summary of its development and intended use. In two prospective clinical trials (ATLAS<\/a> and FLAIR<\/a>), people with virologic suppression and no history of treatment failure or HIV resistance were randomized to receive their current daily oral ART or switch to once-monthly injections of cabotegravir (an integrase inhibitor) and rilpivirine (a non-nucleoside reverse transcriptase inhibitor already available in pill form).<\/p>\n

The results showed that CAB-RPV was noninferior to oral ART. Later, a study (ATLAS-2M<\/a>) demonstrated that these two injections could be given every 2 months. After a delay of several months due to manufacturing issues, it was FDA-approved in January 2021 as a switch strategy for “virologically suppressed adults.”<\/p>\n

Seems simple, right? A straightforward option to offer people with HIV who no longer want to take their daily pill or pills. Progress!<\/p>\n

Indeed, in the clinic for some patients, offering them this option has been wonderful. For reasons often having to do with convenience, privacy, stigma, or pill fatigue, they find the injections a tremendous improvement in their quality of life.<\/p>\n

Some examples, drawn from our clinic (certain details changed for confidentiality):<\/p>\n