Question
Can women use injectable ART including during pregnancy?
23 August 2024. Related: All topics, Injectable ART, Pregnancy, Sexual health.
Hi there. Are long-acting injectibles safe for women of child-bearing age? And can pregnant women have injectibles?
Answer
Hi there
Thanks for your question, which I think mainly relates to long-acting cabotegravir and rilpivirine injections (CAB/RPV-LA). As injectable HIV meds are being used as both treatment and PrEP, the answer also has to think about this too.
This is an HIV combination that is usually given even two months by two injections into your gluteus muscle (in your bottom).
It is used as a switch option for people who already have an undetectable viral load on oral pills. It was also approved about three years ago in the UK.
The first part of your question is easy because CAB-RPV-LA is approved for all adults.
The second part is more complicated because there are limited data about use during pregnancy. This means if you are planning a pregnancy, your doctor might recommend using oral meds again. If you find you become pregnant when on CAB/RPV-LA you doctor might also recommend switching to oral pills. Depending on your circumstances though, you might be able to continue using injections under with close monitoring.
A study presented at the AIDS 2024 conference in July included safety data from about 360 HIV negative women who used injectable CAB-LA as PrEP (without the RPV-LA) or oral PrEP. There were no differences in the pregnancy safety outcomes between the two groups.
However, drug levels of different HIV drugs can change during pregnancy and there can also be differences between HIV positive and negative women. Most doctors are likely to prefer to wait for more data, in someone who is able to switch back to oral meds.
Please see this link for more information on CAB/RPV-LA:
https://i-base.info/guides/15361
Although it is only currently approved to treatment multi-drug HIV resistance, lenacapavir is also a long-acting injection. This drug is given as an injection under the skin every six months. Lenacapavir also needs to be used with other active drugs.
As there is virtually no human data on lenacapavir use during pregnancy, stopping this drug would not be recommended, so would need close monitoring.
Lenacapavir is also being studied as PrEP in HIV negative women, in studies that include pregnancies, and this will also provide safety data
More info on lenacapavir is at this link:
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