Considerations for Discontinuing Cabotegravir and Switching to Descovy

Key Considerations Before Switching

A thorough review of the patient's ART history, prior resistance testing, comorbidities, potential drug interactions, and presence of hepatitis B coinfection is mandatory before making any treatment changes 3
For patients with virologic suppression on cabotegravir, switching to Descovy (emtricitabine/tenofovir alafenamide) should be part of a complete regimen, typically combined with an integrase strand transfer inhibitor (InSTI) like dolutegravir or bictegravir to maintain a high barrier to resistance 1, 2
If switching from injectable cabotegravir plus rilpivirine, the long half-life of these medications requires overlap with the new oral regimen to prevent periods of functional monotherapy 4

Begin oral Descovy-based regimen (typically with bictegravir or dolutegravir) at least 1 month before the next scheduled cabotegravir injection would have been due 4, 5
HIV viral load assessment is recommended 1 month after switching regimens and then every 3 months for the first year 3, 4
For patients with chronic hepatitis B virus (HBV) coinfection, Descovy is an appropriate choice as it contains tenofovir alafenamide, which is active against HBV 3, 6

For patients who had been using long-acting cabotegravir due to adherence challenges with daily oral therapy, additional adherence support should be provided when switching to daily Descovy 2, 4
Patients with previous NRTI resistance should be monitored more closely in the first year after switching to a Descovy-based regimen, especially if there are concerns about adherence 7, 5

Check viral load at 1 month post-switch to ensure continued viral suppression 3, 4
Continue monitoring viral load every 3 months for the first year after switching 7, 5
Review for potential drug interactions with the new regimen, particularly if the patient is taking medications that may interact with tenofovir alafenamide 3, 8

Never discontinue cabotegravir without immediately starting an effective alternative regimen due to the risk of developing resistance during the prolonged elimination phase 4, 5
Do not switch to Descovy monotherapy or with agents having a low genetic barrier to resistance if there is a history of NRTI resistance 3, 6
For patients with chronic HBV, do not switch to a regimen without anti-HBV activity (Descovy contains tenofovir alafenamide which is active against HBV) 3, 6