Dr. Jonathan Angel, from the University Hospital of Ottawa (Canada), reported at the XVIII European AIDS Conference (EACS 2021) on his practical experience prescribing the new injectable antiretrovirals cabotegravir and rilpivirine. In addition to his five years of experience administering them in clinical trials, he is one of the first physicians to offer them in routine care.
Canada was the first country to approve this long-acting antiretroviral treatment, which is sold in North America under the brand name Cabenuva . In Europe, the injectable formulations of each of these two drugs have different brand names: Vocabria and Rekambys .
Dr. Angel stated that administering the injections monthly or bimonthly to a significant number of people could place an additional burden on already busy outpatient services. Supply in Canada has been facilitated by a program sponsored by a pharmaceutical company, called Cabenuva Supports , which actually administers the injections. Nursing staff are responsible for administering the inoculations outside of medical facilities: at primary care centers, pharmacies, or in patients' homes.
Dr. Angel noted that he had found it impossible to predict which patients would show a genuine interest in switching to injectable therapy: aside from simply preferring injections, their motivations were highly personal and often diverse. "When patients are introduced to injectable therapy, they select themselves," he stated.
Most patients have opted for an oral "introductory" period, taking cabotegravir and rilpivirine tablets for four weeks, but some data suggest this may not be necessary, and some people have preferred to skip this oral introductory period. A handful of patients decided to discontinue injections and return to oral therapy, mainly due to "injection fatigue"—the inconvenience of scheduling appointments for injections—and their associated side effects.
An interesting potential use for injectable drugs would be as temporary antiretroviral therapy during periods when people cannot take oral treatment or when there is a fear of an unwanted disclosure of their serological status, for example, while traveling. "We are only at the beginning of using these technologies," commented Dr. Angel, "and we will encounter other clinical and practical issues as more people use them. They won't necessarily solve the problems of people with poor adherence on an ongoing basis, because it's also possible to skip injections. Nevertheless, there is no doubt that a large proportion of people will prefer this formulation."