Cabotegravir

How it works

It inhibits HIV integrase, blocking the strand-transfer step that inserts viral DNA into the host cell genome and so preventing viral replication.

Prescribing in practice

• For pre-exposure prophylaxis, HIV-negative status must be confirmed before each injection, because undiagnosed infection during use risks integrase-inhibitor resistance.
• Its long-acting depot means drug persists for many months after the last dose, so coverage with an alternative agent is needed if injections are stopped.
• Strong inducers such as rifampicin and certain anticonvulsants are contraindicated as they reduce cabotegravir exposure.

Monitoring

Repeat HIV testing before each injection (especially for prophylaxis) and monitor for injection-site reactions and hypersensitivity.

Counselling the patient

• Keep every appointment on schedule, as late injections reduce protection or treatment effect.
• Injection-site soreness, swelling or a small lump is common and usually settles.
• If injections are stopped, you must use another agreed method to stay protected for several months.

Evidence & guidelines

Long-acting cabotegravir prophylaxis efficacy was demonstrated in the HPTN 083 and HPTN 084 trials.