{"id":23767,"date":"2024-08-23T12:15:41","date_gmt":"2024-08-23T12:15:41","guid":{"rendered":"https:\/\/i-base.info\/qa\/?p=23767"},"modified":"2024-09-05T14:40:04","modified_gmt":"2024-09-05T14:40:04","slug":"what-are-the-uk-criteria-to-use-injectable-cab-rpv-la-in-the-uk","status":"publish","type":"post","link":"https:\/\/i-base.info\/qa\/23767","title":{"rendered":"Who can use injectable CAB\/RPV-LA in the UK"},"content":{"rendered":"<p>Hi there<\/p>\n<p>CAB\/RPV-LA is an HIV combination that is given by injection every two months.<\/p>\n<p>As this is a relatively new &#8211; approved in 2021 \u2013 the British HIV Association (BHIVA) recommend the following guidelines for people who are interested in this option.<\/p>\n<p>This is partly because of a small risk of viral rebound with drug resistance, even if you have all the injections on time.<\/p>\n<div class=\"page\" title=\"Page 86\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h2>BHIVA recommended criteria for long-acting cabotegravir\/rilpivirine use<\/h2>\n<p>Based on the entry criteria for the ATLAS-2M trial, we recommend the following criteria for long-acting cabotegravir\/rilpivirine use:<\/p>\n<ul>\n<li>Viral suppression to &lt;50 copies\/mL for at least 6 months and<\/li>\n<li>No known or suspected NNRTI or INSTI resistance and<\/li>\n<li>No history of virological failure on an NNRTI- or INSTI-containing regimen and<\/li>\n<li>No use of INSTI monotherapy and<\/li>\n<li>Ability to commit to 2-monthly attendance for intramuscular injections and<\/li>\n<li>Acceptance of a small risk of virological failure and resistance (approximately 1 in 70 at year 1 and 1 in 60 at year 2) and the implication for U=U and<\/li>\n<li>Where there are only one of the following: baseline rilpivirine polymorphisms, BMI &gt;30 kg\/m2 orsubtype A6\/A1, and<\/li>\n<li>No requirement for a tenofovir-containing regimen for the treatment or prevention of hepatitis B.<\/li>\n<\/ul>\n<h2>People should be counselled that:<\/h2>\n<ul>\n<li>Known or suspected resistance to the either drug or detectable viraemia are exclusions.<\/li>\n<li>They will require an oral lead-in and then two deep gluteal intramuscular injections 1 month apartfollowed by deep gluteal intramuscular injections every 2 months in clinic.<\/li>\n<li>Implementation work shows they can expect to spend 30\u201360 minutes in clinic at each visit.<\/li>\n<li>Adherence is critical with a maximum +\/\u2013 7-day window for early\/late administration; oral bridging can be used but should be considered an exception rather than routine.<\/li>\n<li><span style=\"font-variant-caps: normal;\">In clinical trials, about 1 in 70 people on 2-monthly long-acting cabotegravir\/rilpivirine experienced viral rebound at year 1, and 1 in 60 at year 2, despite 100% adherence, and most of those also developed resistance to one or both drugs.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-size: 1.4em; font-variant-caps: normal;\">Long-acting cabotegravir\/rilpivirine and pregnancy<\/span><\/p>\n<p>There is limited information about injectable treatment in pregnancy so it is not a recommended option. Individuals wishing to conceive can remain on long-acting cabotegravir\/rilpivirine.<\/p>\n<p>Those becoming pregnant on long-acting cabotegravir\/rilpivirine should consult with their physician and come to a joint decision on whether to continue.<\/p>\n<p>Reference<\/p>\n<p>BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022 (2023 interim update). Page 21.<br \/>\n<a href=\"https:\/\/www.bhiva.org\/HIV-1-treatment-guidelines\">https:\/\/www.bhiva.org\/HIV-1-treatment-guidelines<\/a><\/p>\n\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Hi there, I am interested in using injectable ART and I wanted to know about the guidelines for who can use this.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,7,10,57],"tags":[],"class_list":["post-23767","post","type-post","status-publish","format-standard","hentry","category-access-to-treatment","category-adherence","category-all-topics","category-changing-treatment","category-injectable-art"],"_links":{"self":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/23767","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/comments?post=23767"}],"version-history":[{"count":5,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/23767\/revisions"}],"predecessor-version":[{"id":23772,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/posts\/23767\/revisions\/23772"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/media?parent=23767"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/categories?post=23767"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/qa\/wp-json\/wp\/v2\/tags?post=23767"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}