Apretude is an injectable medication used to prevent HIV infection. Specifically, it’s a form of pre-exposure prophylaxis (PrEP) approved for at-risk adults and adolescents weighing at least 35 kg (about 77 pounds). Unlike daily PrEP pills, Apretude is given as an injection every two months after an initial start-up period, making it the first long-acting injectable option for HIV prevention.
How Apretude Prevents HIV
Apretude contains cabotegravir, a drug that blocks a specific enzyme HIV needs to insert its genetic material into human cells. By disabling this step, the virus can’t establish infection even if you’re exposed to it. The drug is suspended in a slow-release formula that, once injected into muscle tissue, gradually releases cabotegravir over weeks, maintaining protective levels in your body between visits.
This makes Apretude fundamentally different from daily oral PrEP. Rather than remembering a pill every day, you receive an injection at a clinic on a set schedule. For people who find daily pills difficult to stick with, or who prefer a more discreet option, the injection removes the daily burden entirely.
Who Can Get Apretude
The FDA approved Apretude for adults and adolescents aged 12 and older who weigh at least 35 kg and are at risk of acquiring HIV through sex. It is not recommended for anyone under 12 or below that weight threshold, as safety and effectiveness haven’t been established in those groups.
“At risk” generally means you have sexual partners whose HIV status is unknown or positive, you’ve had a recent sexually transmitted infection, or you don’t consistently use condoms. Your healthcare provider will assess your individual risk factors to determine whether PrEP is appropriate.
How the Injection Schedule Works
Apretude follows a specific start-up and maintenance schedule. You receive the first injection, then return one month later for a second injection. After that, injections shift to every two months. That means, once you’re past the start-up phase, you visit your provider roughly six times a year.
Before starting, your provider may offer a short course of oral cabotegravir tablets (typically about four weeks) to make sure you tolerate the medication well before committing to injections. This step is optional but gives you a chance to check for side effects before receiving a long-acting dose that stays in your system for weeks.
HIV Testing Before Each Dose
Every time you come in for an injection, you’ll be tested for HIV. This isn’t a formality. If someone develops HIV while taking Apretude, using the drug alone (which targets only one part of the virus’s life cycle) could lead to drug resistance, making future HIV treatment harder. The testing protocol uses both an antigen/antibody test and an HIV RNA test, which together can detect infection earlier than a standard antibody test alone. Your provider will also ask about any symptoms of recent illness that might signal a new infection.
How Effective Apretude Is
Two large clinical trials, HPTN 083 and HPTN 084, compared Apretude head-to-head with daily oral PrEP (tenofovir/emtricitabine, commonly known as Truvada). In HPTN 083, which enrolled cisgender men and transgender women who have sex with men, Apretude reduced HIV infections by 66% compared with daily pills. In HPTN 084, which enrolled cisgender women in sub-Saharan Africa, the reduction was 89%.
These numbers don’t mean daily oral PrEP is ineffective. Both options provide strong protection. The advantage of the injection showed up largely because participants found it easier to stay on schedule with periodic clinic visits than with a daily pill. In other words, a drug you actually take as directed works better than one you sometimes forget.
Common Side Effects
The most frequently reported side effect is a reaction at the injection site. This can include pain, tenderness, swelling, a hardened lump, redness, itching, warmth, bruising, or temporary loss of sensation. For most people, these reactions are mild to moderate and improve within a few days, though some people find the soreness lasts up to a week or so, particularly with the first few injections.
Beyond injection site reactions, other commonly reported side effects include headache, diarrhea, nausea, fever, tiredness, sleep problems, dizziness, muscle pain, back pain, stomach pain, rash, and upper respiratory infections. Most of these overlap with what people experience on oral PrEP as well, and they tend to lessen over time as your body adjusts.
How Apretude Compares to Daily PrEP Pills
Daily oral PrEP has been available since 2012 and remains a highly effective option. The choice between pills and injections comes down to lifestyle, preference, and practicality.
- Convenience: Apretude eliminates the need for daily adherence but requires in-person clinic visits every two months. If you travel frequently or have limited access to a clinic that stocks the injection, daily pills may be simpler.
- Privacy: There’s no pill bottle to store or explain. Your prevention happens at a clinic visit and leaves no visible trace at home.
- Stopping protection: If you decide to stop, daily pills clear your system within days. Cabotegravir lingers in your body for up to a year after the last injection, at levels too low to fully protect you but high enough to potentially drive resistance if you acquire HIV during that tail period. Your provider will typically recommend switching to oral PrEP to cover that gap.
- Cost: Apretude tends to be more expensive than generic oral PrEP, though patient assistance programs and insurance coverage can reduce or eliminate out-of-pocket costs for many people.
The Drug Tail After Stopping
One important detail that sets Apretude apart from pills is what happens after your last injection. Cabotegravir is designed to release slowly, which means traces remain in your bloodstream for many months after you stop. During this “tail” period, drug levels are too low to reliably prevent HIV but still present enough that if you do acquire the virus, it could develop resistance to cabotegravir and related drugs. This is why providers strongly recommend a plan for transitioning to oral PrEP or another prevention method if you decide to discontinue injections.