Cabotegravir-Rilpivirine for HIV-1 Treatment

Eligibility and Contraindications

The American College of Physicians and other medical societies recommend cabotegravir-rilpivirine for HIV-1 treatment in patients with diagnosis code B20, provided the patient meets specific eligibility criteria, including virologic suppression and no history of virologic failure 1, 2
The International Antiviral Society-USA guidelines state that patients must have no known or suspected resistance to either cabotegravir or rilpivirine based on historical genotypic testing 1, 3, 2
Cabotegravir-rilpivirine is contraindicated in patients with documented or suspected rilpivirine resistance, which would compromise treatment efficacy and lead to 2-class resistance development 3, 2
The CDC recommends against using cabotegravir-rilpivirine as initial therapy for treatment-naive patients or for post-exposure prophylaxis due to lack of data on safety, tolerability, and efficacy in these settings 4

The International Antiviral Society-USA guidelines support cabotegravir-rilpivirine as a maintenance therapy option for virologically suppressed patients who meet eligibility criteria 1, 2
The recommended dosing schedules are every 4 weeks (Q4W) or every 8 weeks (Q8W), with the Q8W regimen offering reduced injection frequency while maintaining durable virologic suppression 2
A 4-5 week oral lead-in phase with oral cabotegravir and rilpivirine is critical before initiating long-acting injections to identify potential tolerability issues and confirm virologic suppression 2

The risk of virologic failure with cabotegravir-rilpivirine is 1-2%, with emergence of 2-class resistance (integrase inhibitor + NNRTI) 2
Risk factors for virologic failure include rilpivirine-associated resistance at baseline, viral subtype A6, BMI >30 kg/m², and poor adherence to injection schedule 2
The monitoring schedule includes HIV RNA at 4-6 weeks after starting oral lead-in, every 3 months for the first year after switching to long-acting injections, and every 3-6 months thereafter if stable 2

Cabotegravir-rilpivirine prioritizes quality of life by eliminating daily pill burden, reducing NRTI-related complications, and decreasing stigma and anxiety related to daily oral dosing 2
The treatment maintains durable virologic suppression with 95% suppression rates in clinical trials 2