Cabenuva is given as two separate intramuscular injections, typically into the gluteal (buttock) muscle, at a healthcare provider’s office or through a home health service. Each visit involves one shot of cabotegravir and one shot of rilpivirine, the two antiretroviral drugs that together replace a daily oral HIV regimen. The injections can be given monthly or every two months, depending on the dosing schedule you and your provider choose.
What Happens at Each Injection Visit
Cabenuva is stored refrigerated between 36°F and 46°F. Before your appointment, the medication needs to sit at room temperature for at least 15 minutes. Your provider then prepares two syringes: one containing cabotegravir and the other containing rilpivirine. Both are injected into muscle tissue, one on each side of the buttock. In some cases, the lateral thigh muscle can be used instead, with one injection in each thigh. A phase 3 study confirmed thigh injections as a viable alternative for people who prefer or need a different site.
The entire process, from preparation to injection, is relatively quick once the medication has reached room temperature. You’ll stay briefly afterward so your provider can monitor for any immediate reactions.
Monthly vs. Every-Two-Month Dosing
Cabenuva offers two dosing schedules, and the initiation phase differs slightly for each.
For the monthly schedule, you start with a single set of higher-dose initiation injections: 600 mg (3 mL) of cabotegravir and 900 mg (3 mL) of rilpivirine. After that first visit, each monthly continuation visit uses lower doses: 400 mg (2 mL) of cabotegravir and 600 mg (2 mL) of rilpivirine.
For the every-two-month schedule, you receive two initiation visits one month apart. Both visits use the higher dose: 600 mg (3 mL) of cabotegravir and 900 mg (3 mL) of rilpivirine each time. Starting at month four, you continue with those same higher doses but space visits out to every two months.
Clinic Visits vs. Home Administration
Cabenuva must be given by a healthcare professional, so you cannot self-inject at home. However, it doesn’t have to happen in a clinic. Research published in Open Forum Infectious Diseases found that at-home administration by a visiting healthcare practitioner is feasible, comparably safe and effective, and in many cases preferred by patients. Whether home health services are available to you depends on your insurance coverage, but if offered, you can start in one setting and switch to the other later.
What the Injection Feels Like
Injection site reactions are common but overwhelmingly mild. Across clinical trials, pain at the injection site occurred with about 20% of injections. Other reactions like nodules, hardness, discomfort, or swelling each occurred in less than 1% of injections. Nearly all reactions (99%) were mild to moderate, and they typically resolved within about three days, with most lasting between two and four days. Many people find that reactions become less noticeable over time as they continue treatment.
What Happens if You Miss a Visit
You have a seven-day window on either side of your scheduled appointment. If your visit is set for a Tuesday, for example, you can come in anytime from the previous Tuesday through the following Tuesday without any change in protocol.
If you know you’ll miss your appointment by more than seven days, your provider can prescribe oral cabotegravir plus rilpivirine (or another fully suppressive oral HIV regimen) to bridge the gap for up to two months until you can get back on track with injections. If you miss your window by more than seven days and haven’t taken any oral therapy in the meantime, your provider will need to reassess whether restarting injections is appropriate, since a gap in treatment can increase the risk of the virus developing resistance.
How to Prepare for Your First Visit
Your provider will confirm that your viral load is suppressed on your current oral regimen before switching to Cabenuva. On the day of your appointment, wearing loose, comfortable clothing makes access to the injection site easier. Some people find that applying a warm compress to the area afterward helps with soreness. Plan for mild tenderness over the next few days, particularly after your first injection, and keep in mind that the higher-volume initiation doses (3 mL per shot) can feel slightly more noticeable than the smaller continuation doses used in the monthly schedule.