Combining injectable lenacapavir and cabotegravir-LA

A viewpoint article in JAMA expands on the potential for combining two injectable HIV drugs in a novel combination that has so far only been used by independent researchers and doctors.

The article also reports on a multi-stakeholder meeting held in 2024 to develop a consensus approach to working with drug companies to expand access to long-acting injectable ART. It argues the potential public health benefits of combining cabotegravir-LA and lenacapavir, particularly for people living in low- and middle-income countries (LMICs).

Cabotegravir-LA was approved in 2021 for use in combination with rilpivirine-LA as a switch option for people with viral suppression on oral ART. It is given by intramuscular injection every two months.

Lenacapavir was approved in 2022 to be used in combinations with other drugs to treat multiple drug resistant HIV. It is given by subcutaneous injection every six months and also being studied for first-line and switch options and for PrEP.

The article concludes: “Just as once-daily fixed-dose oral antiretrovirals transformed HIV care in the last decade, long-acting antiretrovirals for treatment could mark the next paradigm shift, offering sustained viral suppression in a manner that can both accelerate and sustain epidemic control”.

Ehrenkranz PD et al. Long-Acting HIV Treatment in Low- and Middle-Income Countries: Addressing the Public Health Need. JAMA. Published online May 19, 2025. doi:10.1001/jama.2025.5180
jamanetwork.com/journals/jama/fullarticle/2834158