Cabenuva is a groundbreaking prescription treatment for HIV-1 infection. Unlike traditional daily oral antiretroviral therapy (ART), Cabenuva is a long-acting injectable option that combines two medicines—cabotegravir and rilpivirine—administered by a healthcare provider once a month or every two months.
This innovative therapy provides an alternative for people living with HIV who want freedom from daily pills, while maintaining effective viral suppression.
In this comprehensive, patient-friendly guide, you’ll learn what Cabenuva is, how it works, who it’s for, dosage and injection details, possible side effects, safety precautions, cost, and answers to common questions.
Quick Disclaimer
This article is for educational purposes only and not a substitute for professional medical advice. Always follow your healthcare provider’s instructions regarding HIV treatment.
What Is Cabenuva?
Cabenuva is the brand name for the combination of:
- Cabotegravir (an integrase strand transfer inhibitor, INSTI)
- Rilpivirine (a non-nucleoside reverse transcriptase inhibitor, NNRTI)
These two drugs work together to suppress HIV replication and help maintain viral load at undetectable levels.
Unlike oral tablets taken daily, Cabenuva is given as an intramuscular injection into the buttocks, administered by a healthcare professional either:
- Once every month
- Once every two months (depending on your doctor’s plan and your response)
How Does Cabenuva Work?
Cabenuva blocks HIV at two different steps of its replication process:
- Cabotegravir: Prevents HIV DNA from being integrated into human cells.
- Rilpivirine: Stops the virus from making copies of itself by blocking reverse transcriptase.
Together, they maintain viral suppression (undetectable viral load), which helps protect the immune system and prevents HIV from progressing.
✅ Important Note: Cabenuva is for people who are already virologically suppressed on an oral HIV regimen (usually for at least 6 months) before switching.
Common Uses of Cabenuva
Doctors may recommend Cabenuva for:
- Adults living with HIV-1 infection who are stable and undetectable on oral ART.
- People seeking an alternative to daily pills for privacy, convenience, or adherence reasons.
- Patients without prior treatment failure and without known drug resistance to cabotegravir or rilpivirine.
Not for:
- Individuals with untreated or uncontrolled HIV.
- People with resistance to integrase inhibitors or NNRTIs.
- Anyone with certain drug interactions (see below).
Cabenuva Dosage and Administration
Step 1: Oral Lead-In (Optional)
Some clinicians may start patients on oral cabotegravir + rilpivirine tablets for ~1 month to ensure tolerability.
Step 2: Intramuscular Injection
Cabenuva is administered as two separate injections (one cabotegravir, one rilpivirine) into the buttocks muscle.
- Monthly schedule: Given every 4 weeks.
- Every-2-month schedule: Given every 8 weeks (after initial loading doses).
Missed Dose
If you miss your injection appointment, contact your healthcare provider immediately. Missing doses may increase the risk of viral rebound or resistance.
Injection Site and Tips
- Injections are given by a trained provider only.
- Common injection sites: gluteal muscle (buttock area).
- Patients should relax muscles during injection to reduce discomfort.
Side Effects of Cabenuva
Most people tolerate Cabenuva well, but side effects can occur.
Common Side Effects (mild to moderate)
- Injection site pain, redness, swelling, or hardness
- Fever or fatigue
- Headache
- Nausea or diarrhea
- Sleep disturbances (insomnia or vivid dreams)
Less Common but Important
- Depressive mood changes or anxiety
- Rash or allergic reaction
- Liver problems (rare) – signs include yellowing of skin/eyes, dark urine
- Hypersensitivity reactions
If you experience severe rash, breathing problems, or mood changes, seek medical help immediately.
Warnings and Precautions
- Drug Interactions: Cabenuva should not be used with certain medicines (e.g., rifampin, rifapentine, St. John’s Wort, certain anticonvulsants). Always share your medication list with your doctor.
- Pregnancy & Breastfeeding: Limited data is available. Discuss with your healthcare provider if you are pregnant or planning pregnancy.
- Hepatitis B or C Co-Infection: Extra monitoring may be required.
- Liver Impairment: Use with caution in people with moderate to severe liver issues.
Drug and Product Interactions
Cabenuva may interact with medications that induce or inhibit liver enzymes, such as:
- Rifampin, rifapentine (TB drugs)
- Carbamazepine, oxcarbazepine, phenobarbital (seizure drugs)
- St. John’s Wort (herbal supplement)
Your healthcare provider will review your prescriptions and adjust if necessary.
Cabenuva vs. Daily Oral HIV Therapy
| Feature | Cabenuva | Daily Oral ART |
|---|---|---|
| Dosing | Monthly or every 2 months injection | Daily pill(s) |
| Convenience | No daily pill burden | Requires strict adherence |
| Privacy | Discreet, no visible pills | Visible bottles may raise stigma concerns |
| Side Effects | Mostly injection site reactions | Mostly GI issues, metabolic |
| Flexibility | Requires clinic visits | Can be self-administered at home |
Cost, Availability & Insurance
- Cost: Cabenuva is significantly more expensive than generic oral HIV regimens. Estimated list price: $3,900–$4,500 per month (varies by region and insurance).
- Insurance: Many insurance plans, Medicare, and Medicaid may cover Cabenuva with prior authorization.
- Manufacturer Support: ViiV Healthcare offers patient assistance programs to reduce out-of-pocket costs.
Special Section: Monthly vs. Every-2-Month Injections
- Monthly Cabenuva: Suitable for those new to injections or who prefer closer monitoring.
- Every-2-Month Cabenuva: Provides greater freedom, fewer clinic visits, and increased convenience once patients are stable.
Both schedules are equally effective at maintaining viral suppression.
Proper HIV Care with Cabenuva
- Keep all clinic appointments to prevent viral rebound.
- Inform your doctor of all medications and supplements.
- Continue routine blood tests (viral load, CD4 counts, liver tests).
- Report any unusual side effects promptly.
Frequently Asked Questions (FAQs)
Q1. What is Cabenuva used for?
Cabenuva is used to treat HIV-1 infection in adults who are stable and virologically suppressed.
Q2. Is Cabenuva a cure for HIV?
No. Cabenuva controls HIV but does not cure it.
Q3. Can I switch to Cabenuva if I’m on oral ART?
Yes, if your viral load is undetectable and you meet eligibility requirements.
Q4. How often do I need injections?
Either monthly or every 2 months, depending on your provider’s plan.
Q5. What if I miss an injection?
Contact your provider immediately. A backup oral regimen may be prescribed.
Q6. Can Cabenuva be used for PrEP (HIV prevention)?
No. Cabenuva is for treatment, not prevention. Cabotegravir (Apretude) is approved for PrEP.
Q7. How painful are the injections?
Mild to moderate soreness is common but usually temporary.
Q8. Does Cabenuva interact with other medicines?
Yes. Certain TB, seizure, and herbal drugs may reduce effectiveness.
Q9. Is Cabenuva safe during pregnancy?
Limited data is available. Discuss risks and benefits with your doctor.
Q10. What’s the difference between Cabenuva and oral pills?
Cabenuva removes the need for daily pills but requires regular clinic visits.
Q11. How much does Cabenuva cost?
Around $3,900–$4,500 per month before insurance or discounts.
Q12. Who manufactures Cabenuva?
Cabenuva is developed by ViiV Healthcare, in partnership with Janssen (Johnson & Johnson).
Final Thoughts
Cabenuva represents a major advancement in HIV treatment—the first long-acting injectable regimen that offers freedom from daily pills. When taken as prescribed, it is safe, effective, and convenient for maintaining viral suppression.
