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The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation

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Abstract

The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

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Funding

This work was supported by the National Institutes of Health [R01MH123262 to KM and SAG; K23AI150378 to JZ; K23-MH124569 to BAK; UM1AI069470 to MES; P30-MH43520 to RHR].

Author information

Authors and Affiliations

  1. Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, 701 W. 168th Street, HHSC 1102, 10032, New York, NY, USA

    Kathrine Meyers & Nadia Nguyen

  2. Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Jason E. Zucker, Magdalena E. Sobieszczyk & Michael T. Yin

  3. HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA

    Bryan A. Kutner

  4. NYP HIV Prevention Program, New York-Presbyterian Hospital, New York, NY, USA

    Caroline Carnevale

  5. Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Delivette Castor

  6. Department of Psychology, Hunter College, City University of New York, New York, NY, USA

    Sarit A. Golub

  7. Basic and Applied Social Psychology (BASP) PhD Program, Graduate Center of the City University of New York, New York, NY, USA

    Sarit A. Golub

  8. Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, NY, USA

    Sarit A. Golub

  9. HIV Center for Clinical and Behavioral Studies, State Psychiatric Institute, Columbia University, New York, NY, NY, USA

    Robert H. Remien

Authors
  1. Kathrine Meyers
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  2. Nadia Nguyen
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  3. Jason E. Zucker
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  9. Sarit A. Golub
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Contributions

KM, NN, JZ, MTY were responsible for conceptualization; KM, NN, JZ wrote the original draft; BAK, MTY, and RR reviewed and edited the original draft; SAG, MES, CC, DC reviewed and edited additional drafts. All authors reviewed, edited, and approved the submitted manuscript.

Corresponding author

Correspondence to Kathrine Meyers.

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Conflict of interest

MES has received grants to her institution from NIH, GSK and ViiV Healthcare to conduct clinical trials of Long-Acting Cabotegravir for treatment and prevention outside of the submitted work. No authors have a conflict of interest.

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Meyers, K., Nguyen, N., Zucker, J.E. et al. The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation. AIDS Behav 27, 4–9 (2023). https://doi.org/10.1007/s10461-022-03816-0

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