For most people, HIV treatment means a pill every day for life. Cabenuva offers another way: two injections, given in a clinic once a month or once every two months, instead of daily tablets. For some people that is a real relief. But it is not for everyone, and it comes with rules that pills do not.
A note before we start: OnlineMeds does not supply Cabenuva or any HIV injection. It is given by healthcare providers in clinics. This guide is here to help you decide whether to ask your HIV team about it.
What Cabenuva is
Cabenuva is a complete HIV treatment made of two long-acting medicines: cabotegravir (an integrase inhibitor) and rilpivirine (an NNRTI). They are given as two separate injections into the buttock muscles by a healthcare provider, either monthly or every two months1. In Europe the same two medicines are sold as Vocabria (cabotegravir) and Rekambys (rilpivirine), both authorised in December 202023.
Who can switch to it
Cabenuva is a switch option, not a first treatment. The US label allows it for adults and adolescents aged 12 or over who weigh at least 35 kg and who1:
- are already undetectable (viral load below 50 copies/mL) on a stable HIV regimen
- have no history of treatment failure
- have no known or suspected resistance to cabotegravir or rilpivirine
In England, NICE recommends it on similar terms for adults with no resistance to, and no past failure on, NNRTIs or integrase inhibitors4. The US label also asks prescribers to think carefully if your past NNRTI treatment history is incomplete or uncertain, because hidden NNRTI resistance was linked to a higher chance of the treatment failing1. If you are not sure about your treatment history, say so.
What starting and the clinic visits involve
- An optional tablet lead-in. You and your provider can choose to take cabotegravir and rilpivirine as tablets for a short time first, to check you tolerate them, or go straight to injections1.
- Monthly or every two months. Your provider will discuss which schedule suits you best1.
- Two injections each visit, one of each medicine, into the buttock muscles. People with a higher body weight may need a longer needle so the medicine reaches the muscle1.
- Keeping to the schedule matters. Injection dates are fixed in advance, and your clinic will want to see you on time.
Side effects
The most common side effects are reactions at the injection site, such as pain, swelling or a lump. Others listed on the US label include fever, tiredness, headache, muscle and bone pain, nausea, sleep problems, dizziness and rash1.
Less common but important1:
- Allergic reactions, including serious skin reactions. Stop and get help straight away if you develop a rash with fever, blisters, or swelling of the face.
- Reactions right after the injection. In fewer than 1 in 100 people in the trials, symptoms such as breathlessness, stomach cramps, sweating, numb mouth, flushing or dizziness started within minutes of the rilpivirine injection and began to settle within minutes. The label asks clinics to watch you for about 10 minutes after each injection.
- Liver problems, so liver blood tests are part of monitoring.
- Low mood or depression, which should be raised with your team promptly.
Missing a visit, and the “tail” after stopping
Both medicines stay in the body at slowly falling levels for up to 12 months or longer after the last injection1. That long tail is why the rules matter:
- If you know you will miss a visit by more than 7 days, your provider can give you daily cabotegravir and rilpivirine tablets, or another full oral regimen, to cover the gap1. Tell your clinic as early as you can.
- If you stop Cabenuva, a full daily regimen must be started no later than 1 month after the last injections if you were on monthly dosing, or 2 months if you were on two-monthly dosing1. Otherwise the falling drug levels can let the virus come back and become resistant.
Interactions
Cabenuva must not be used with some epilepsy medicines (carbamazepine, oxcarbazepine, phenobarbital, phenytoin), the TB medicines rifampicin, rifabutin and rifapentine, more than a single dose of the steroid dexamethasone, or St John’s wort, because they lower the levels of the medicines1. Our guide to HIV medicine interactions covers more.
Cabenuva vs a daily pill such as Biktarvy
| Cabenuva | Biktarvy | |
|---|---|---|
| How taken | Two injections by a provider, monthly or every 2 months1 | One tablet a day at home5 |
| Who can use it | Only people already undetectable, switching from another regimen1 | People starting treatment and people switching5 |
| Hepatitis B | Contains no tenofovir, emtricitabine or lamivudine | Its emtricitabine and tenofovir alafenamide also act on hepatitis B5 |
| After stopping | Long tail: a new regimen must start within 1 to 2 months1 | Leaves the body much faster: the half-life of bictegravir is about 17 hours5 |
| Generic available | No | Licensed generics made in India |
Hepatitis B deserves a note. Cabenuva does not contain the HIV medicines that also act on hepatitis B, and in the trials a few people stopped because of a new hepatitis B infection1. If you are not immune to hepatitis B, ask about vaccination; if you have hepatitis B, your team will consider this carefully. Our hepatitis B treatment guide explains more.
For a wider comparison of daily pills, see Dovato vs Biktarvy vs Triumeq. For prevention injections (PrEP), which are different medicines and doses, see the PrEP shot.
Who might prefer which
- Cabenuva may suit you if daily pills are a burden or a reminder you would rather not have, you want privacy at home, and you can reliably attend clinic visits.
- A daily pill may suit you if you travel a lot or cannot commit to fixed clinic dates, have hepatitis B, have a complicated or unknown treatment history, or prefer to manage treatment yourself.
Daily HIV pills we supply include Biktarvy, its generic Taffic and Doluvir 50 mg (dolutegravir). All need a prescription.
Frequently asked questions
What is Cabenuva?
A complete HIV treatment of two long-acting injections, cabotegravir and rilpivirine, given by a healthcare provider once a month or once every two months instead of daily pills.
Can I start HIV treatment with Cabenuva?
No. It is approved only for people who are already undetectable on another regimen, with no history of treatment failure and no resistance to its two medicines.
What are the side effects of Cabenuva?
Injection site reactions are the most common. Fever, tiredness, headache, muscle pain, nausea, sleep problems, dizziness and rash are also listed. Rarely there are allergic reactions, short reactions right after the injection, liver problems or low mood.
Is Cabenuva better than Biktarvy?
Neither is better for everyone. Cabenuva removes daily pills but needs clinic visits and is only for people already undetectable. Biktarvy is a daily pill that can be used to start treatment and also treats hepatitis B.
What happens if I miss a Cabenuva injection?
If you know in advance, your clinic can give you tablets to cover the gap. If a visit is missed unexpectedly, contact your clinic as soon as possible so they can restart the schedule safely.
Does OnlineMeds sell Cabenuva?
No. Cabenuva is given by healthcare providers in clinics. We supply daily HIV pills, including licensed generics, with a prescription.
Sources & references
- US National Library of Medicine, DailyMed. Cabenuva (cabotegravir and rilpivirine) prescribing information.
- European Medicines Agency. Vocabria (cabotegravir): EPAR.
- European Medicines Agency. Rekambys (rilpivirine): EPAR.
- National Institute for Health and Care Excellence. Cabotegravir with rilpivirine for treating HIV-1 (TA757). 5 January 2022.
- US National Library of Medicine, DailyMed. Biktarvy prescribing information.
Related reading
This content is for informational purposes only and is not medical advice. Whether Cabenuva suits you depends on your treatment history and test results, so discuss it with your HIV team. Never stop or change HIV medicine on your own. Used as prescribed by a licensed medical professional.
Sangeeta Shukla is a licensed clinical pharmacist with 19 years of experience. She holds a B.Pharm and M.Pharm from Zaporozhye State Medical University. At OnlineMeds, she reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.