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What should we know about injectable HIV treatment?

Darien Taylor explains.

Since the arrival of effective treatment, HIV medications have always been pills. As treatment has evolved through the years, the number of pills in someone’s regimen has dropped: where you might have taken fistfuls of pills in the 1990s, your treatment can now be a single daily tablet. But a new medication is transforming the way HIV is managed. Cabenuva—a combination of cabotegravir (an integrase inhibitor) and rilpivirine (a “non-nuke”)—is the first injectable HIV drug approved in Canada. Instead of taking daily pills, all you need are injections every one or two months.

Cabenuva is injected into the muscle of the buttocks by a healthcare professional. Sébastien Poulin, a physician at Clinique I.D. in St-Jérôme and Clinique du Quartier Latin and Clinique L’Agora in Montreal, is one of the first doctors administering Cabenuva to his patients. In Poulin’s clinics, staff carefully select patients who are good candidates. “Cabenuva is not for everyone,” he says, “but we are prescribing it often in our clinic and it’s working well.” The ideal candidate is someone who, for whatever reason, is struggling to take pills every day. They must be virally suppressed on their current treatment and have no resistance to the drugs in Cabenuva. Clinic staff must also be confident that the patient will make all their appointments. This is important to remain virally suppressed.

Transitioning from your current HIV treatment to long-acting injections can’t be done overnight. It begins with an “oral induction” phase in which you take pills that contain the same drugs as Cabenuva. This phase lasts for a month. If there are no concerning side effects during this phase, then injections can begin. These injections must be given by a doctor or nurse, and in Alberta they can also be given by a pharmacist. Poulin believes that most people enjoy having this closer relationship with their healthcare team. “They feel connected and heard,” he says. And as far as side effects go, he says patients aren’t reporting anything aside from temporary swelling and pain at the injection site.

Cabenuva is now on formulary in every province except British Columbia. Overall, Dr. Poulin explains, the injectable treatment “gives another good option to people with HIV that may fit well with their lifestyle and personal preferences.” It gives his patients one less thing to worry about. “They love the freedom of Cabenuva,” he says. “They say they would never go back to oral HIV medications.”

Darien Taylor has been living with and working in HIV for the past thirty-plus years.