Long-acting injectable medications represent a significant evolution in managing Human Immunodeficiency Virus (HIV). These shots offer new ways to either prevent HIV infection in individuals at risk or treat those already living with the virus. They provide an alternative to traditional daily oral pill regimens. These injectable therapies are not a vaccine or a cure for HIV infection. Instead, they serve as powerful tools within a comprehensive HIV management strategy.
Injectable HIV Prevention
Injectable medication for HIV prevention falls under Pre-Exposure Prophylaxis (PrEP). PrEP involves taking medication to reduce the risk of acquiring HIV before potential exposure. The specific injectable medication approved for this purpose is cabotegravir, marketed as Apretude.
Cabotegravir functions as an integrase strand transfer inhibitor (INSTI). It works by blocking the HIV integrase enzyme, which the virus needs to replicate. By preventing viral DNA from integrating into human immune cells, it stops the virus from establishing an infection after exposure.
This injectable PrEP option is for adults and adolescents weighing at least 35 kilograms who are at substantial risk of sexually acquired HIV-1 infection. Before initiating and with each subsequent injection, individuals must undergo an HIV-1 test to confirm their negative HIV status. Eligible individuals include cisgender men who have sex with men, transgender women who have sex with men, and cisgender women at risk.
Injectable HIV Treatment
Long-acting injectable medication also provides a treatment option for individuals living with HIV. This form of antiretroviral therapy (ART) involves a combination of two medications: cabotegravir and rilpivirine, available as Cabenuva. These drugs work to suppress the HIV virus.
Cabotegravir, an integrase strand transfer inhibitor, prevents viral DNA from integrating into human cells. Rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI), blocks another enzyme necessary for viral replication. Together, these actions keep the viral load suppressed to undetectable levels, which is crucial for maintaining health and preventing HIV transmission.
Eligibility for injectable HIV treatment is specific. This option is for adults and adolescents aged 12 years and older, weighing at least 35 kilograms, who have achieved viral suppression (HIV RNA level below 50 copies/mL) on a stable oral antiretroviral regimen. Patients must also have no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine. Sustained viral suppression for at least three to six months on oral therapy is often a prerequisite before transitioning to this injectable regimen.
The Administration Process and Dosing
Receiving HIV injectable medications, whether for prevention or treatment, involves a specific administration process. Both types of injections are given intramuscularly, directly into a muscle. The preferred site for these injections is typically the gluteal muscle, located in the buttocks.
A healthcare professional must administer these injections in a clinical setting. Patients can expect two separate injections for treatment with Cabenuva, one for each medication. This process cannot be done by the patient themselves.
The dosing schedule varies between prevention and treatment. For HIV prevention, cabotegravir (Apretude) is administered as two initial doses one month apart, followed by a maintenance injection every two months. For HIV treatment, the combination of cabotegravir and rilpivirine (Cabenuva) can be given either monthly or every two months. This regimen also begins with two initial doses administered one month apart. An optional oral lead-in period may be used before starting the injections to assess tolerance, though direct-to-injection initiation is also possible.
Comparing Injectables to Oral Medication
Injectable HIV medications offer a distinct alternative to daily oral pill regimens. A primary advantage of injectables is overcoming the burden of daily adherence. For many individuals, remembering to take a pill every single day can be challenging, potentially leading to missed doses and reduced treatment effectiveness.
Injectable options significantly reduce this daily responsibility, requiring administration only once every one or two months. This less frequent dosing can alleviate the stress and stigma often associated with daily pill-taking, offering greater privacy and convenience. The shift from a daily reminder of HIV status to less frequent clinic visits can also improve overall treatment satisfaction.
Both oral and injectable medications can cause side effects, but their profiles differ. Oral pills can have systemic side effects, while injectables primarily cause injection site reactions. These reactions can include pain, tenderness, swelling, bruising, or redness at the injection site. While typically mild to moderate and resolving within a few days, these localized reactions are a common experience for individuals receiving the shots. Other potential side effects, such as headache, fever, or fatigue, can occur with both forms of medication.