While the injectable HIV treatment regimen cabotegravir/rilpivirine (Cabenuva) is an increasingly important option, including for people who have struggled with adherence to daily tablets, it comes with a caution that must be discussed with each patient.
Around 1.5% of people who switch to the injections experience virologic failure, often despite perfect adherence to the injection schedule. While this rate is not higher than that for daily oral HIV regimens, failures are frequently accompanied by resistance-associated mutations.
Since cabotegravir is an integrase inhibitor — as are dolutegravir and bictegravir, the most frequently used anchor drugs in modern HIV treatment — the development of resistance to integrase inhibitors risks significantly limiting future HIV treatment options. Virologic failure on cabotegravir/rilpivirine is therefore considered “a low incidence but high consequence event” (a phrase shared by Saye Khoo at the Conference on Retroviruses and Opportunistic Infections earlier this year). But there is limited data and a lack of guidance on the most effective regimens to use following failure associated with resistance.
Read the full news story by Roger Pebody at Medscape /free registration required/.
Source : Medscape
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