Which drugs are available as injections?
Long-acting injectable treatment currently consists of two drugs, Cabotegravir (also known as Vocabria®) and Rilpivirine (also known as Rekambys®).
Each is packaged separately but they are always given at the same time. This means that at each clinic appointment, you will be given two intramuscular (into the muscle) injections, one into each hip. More long-acting drugs are in the pipeline.
What are the benefits of long-acting injectable HIV treatment?
This can be good for people who do not like to take tablets every day, find it difficult to remember to take their tablets or have swallowing difficulties. It could also be good for people without stable housing or for those who are concerned about confidentiality. For others it will be based on personal preference.
Can everybody use long-acting injectable HIV treatment?
Injectable Cabotegravir and Rilpivirine are not suitable for everyone. We are guided by the evidence that is available from the research studies that tested the medication and by recommendations made by the British HIV Association (BHIVA). The criteria for injections are likely to change over time as more evidence is available.
Current criteria for switching to injectable treatment
- An undetectable viral load (<40) for at least 6 months – although if you have found it difficult to achieve this, the clinic may be able to support you to reach this.
- No resistance to both Cabotegravir and Rilpivirine.
- No treatment failure or unplanned stops to these medications or medications within the same groups (NNRTI and INSTI).
- Not needing to take treatment for Hepatitis B.
- Not taking any interacting medication – your doctor or pharmacist will check this. It is often possible to make changes to your other drugs so you can use injections.
- Not pregnant or planning pregnancy – this may change in the future when we have more experience of using these drugs.
How would switching to long-acting injectable HIV treatment work?
At your appointment with the pharmacist, agree a ‘first target treatment date’. This will be when your first injections will be given and needs to give time to complete an oral lead-in of the drugs in a tablet form.
Think about when you have holidays planned or when you may not be able to attend appointments.
First appointment
Start oral lead-in – most people will start with taking a tablet version of the medication for 30 days to make sure the drugs do not cause side-effects. This would be two tablets, taken together, once daily with food.
Second appointment (first target treatment date)
First injections – after completing a 30 day course of tablets. You will be given your first two injections on this day, one in each hip. You will also have your bloods checked, including your HIV viral load. The first injection sets the schedule for your future treatment dates.
Third appointment
Second injections – attend clinic one month after having your first set of injections. You will be given two more injections, and your blood tests will be repeated.
Ongoing appointments
You will then continue to attend the clinic every two months for ongoing injections and for blood tests. These appointments must be within 7 days of your target treatment date to avoid treatment failure.
What are the potential downsides to long-acting injectable HIV treatment?
- Not everyone will meet the criteria for injectable treatment at present. The criteria are there to make sure that people do not come to harm from switching to injections. However other Long-acting treatments are in the research phase.
- You will need to attend clinic monthly initially and then every two months. There will be little flexibility around appointment dates, particularly when compared to people taking ARV tablets.
- You can expect to spend 30-45 minutes in the clinic at each visit.
- At each visit you will receive two injections into your hips and will have your blood taken.
- Reactions at the site of injection are common although usually mild.
- With all HIV medication there is a risk of resistance and treatment failure. We will check your bloods at every injection appointment.
Other frequently asked questions (FAQs) about long-acting injectable treatment for HIV
What do I do if I miss a dose of my oral lead in?
If you have missed a dose, take it as soon as you remember and continue all future doses at the time they are due.
If I miss my treatment appointment, can I reschedule?
Yes, if this happens, please contact us as soon as you can to rebook an appointment.
Can I stop having injections and go back to tablets?
Yes, you can. This needs to be managed carefully to make sure that you have no breaks in your treatment. If you are experiencing side-effects or struggling to meet the injections schedule, let us know as soon as possible so that we can plan your transition back to a tablet regime.
I am interested in injectable treatment, what do I do?
Contact your clinic doctor or the Lawson Unit nursing team, our team are here to answer your questions and offer advice.
Would starting new medications affect my injectable treatment?
There are a number of medications that can interact with anti-retroviral treatment, please contact the pharmacy team on 01273 664948 if you are starting a new medication.