Does Cabenuva (rilpivirine and cabotegravir) injection cause erectile dysfunction (ED)?

Cabenuva Injection and Erectile Dysfunction

Based on the available evidence, Cabenuva (cabotegravir and rilpivirine) injection has not been associated with erectile dysfunction as a side effect.

Understanding Cabenuva

Cabenuva is the first long-acting injectable antiretroviral therapy for HIV treatment, consisting of cabotegravir and rilpivirine in a nano-formulation 1. It offers several advantages over daily oral antiretroviral therapy:

• Reduces treatment frequency to monthly or every-other-month administration, potentially improving adherence 2
• Maintains high levels of virologic control in real-world settings 2, 3
• May minimize risk of treatment-related toxicity and resistance related to sub-optimal adherence 1

Side Effects of Cabenuva

In clinical studies and real-world data, the most common side effects of Cabenuva include:

• Injection site reactions (29% of patients, mostly grade 1-2) 3
• No serious adverse events directly attributed to the medication in real-world studies 3

Erectile Dysfunction and HIV Treatment

While erectile dysfunction (ED) is a common concern among patients receiving various medications, the available evidence does not indicate that Cabenuva causes ED:

• None of the provided guidelines or research studies list erectile dysfunction as a side effect of Cabenuva 1, 2, 3
• The most recent European Association of Urology guidelines (2025) on erectile dysfunction do not mention Cabenuva or its components as causes of ED 4

Causes of Erectile Dysfunction

For context, ED can be caused by various factors that should be considered when evaluating a patient with both HIV and ED:

• Cardiovascular disease (ED is a risk marker for cardiovascular disease) 4
• Endocrine disorders, particularly low testosterone 4
• Psychological factors including anxiety, depression, and stress 4
• Other medications (not including Cabenuva based on available evidence) 4

Management of ED in Patients on Cabenuva

If a patient on Cabenuva experiences ED, the approach should follow standard ED management guidelines:

1. Assess for modifiable risk factors (smoking, alcohol consumption, physical inactivity) 4
2. Consider laboratory tests including glucose-lipid profile and testosterone levels 4
3. First-line treatment typically includes PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) 4
4. Second-line options include intraurethral alprostadil, intracavernosal injections, or vacuum devices 4

Clinical Implications

For healthcare providers managing patients on Cabenuva who report ED:

• Do not assume Cabenuva is the cause of ED, as the evidence does not support this association 1, 2, 3
• Evaluate for other common causes of ED as outlined in current guidelines 4
• Consider that improved adherence with Cabenuva may actually benefit overall health outcomes, potentially including sexual function 5

In conclusion, patients concerned about ED should be reassured that Cabenuva has not been associated with erectile dysfunction in clinical studies or real-world data, and standard ED evaluation and management approaches should be followed.