Timing of Stribild Discontinuation Before Starting Cabenuva
Patients should continue Stribild until the day of their first Cabenuva injection, with no gap in antiretroviral coverage required. 1, 2
Transition Protocol
The optimal approach is to administer the first Cabenuva injection while the patient is still virologically suppressed on Stribild, ensuring seamless transition without treatment interruption. 1, 2
Key Timing Considerations
- Stribild should be taken on the same day as the first Cabenuva injection, then discontinued immediately after the injection is administered 1, 2
- No washout period is necessary between stopping Stribild and starting Cabenuva, as maintaining continuous viral suppression is the priority 1, 2
- The patient must have documented viral suppression (HIV-1 RNA <50 copies/mL) on their current Stribild regimen before transitioning 1, 2
Pre-Transition Requirements
Before initiating Cabenuva, confirm the following:
- Viral suppression must be documented with HIV-1 RNA <50 copies/mL on at least one measurement while on Stribild 1, 2
- Creatinine clearance must be ≥50 mL/min to have been safely taking Stribild, though this restriction does not apply to Cabenuva itself 3
- Screen for archived resistance mutations, particularly NNRTI resistance-associated mutations to rilpivirine, as these increase risk of virological failure with Cabenuva 2
Critical Clinical Considerations
Renal Function Advantage
- Patients transitioning from Stribild may benefit from improved renal safety with Cabenuva, as Stribild contains tenofovir DF which requires discontinuation at CrCl <50 mL/min 3
- Cabenuva (cabotegravir/rilpivirine) does not require renal dose adjustment and may be preferable for patients with declining renal function 1, 2
Resistance Screening
The presence of archived NNRTI resistance mutations is a critical risk factor for Cabenuva failure. 2
- In the ATLAS-2M study, 63% (5 of 8) of patients with confirmed virological failure on Cabenuva had archived NNRTI resistance-associated mutations to rilpivirine at baseline 2
- Review all prior resistance testing results before switching, as Stribild contains elvitegravir (an INSTI) but Cabenuva contains rilpivirine (an NNRTI) 2
Monitoring After Transition
- Measure HIV-1 RNA at 4 weeks after the first Cabenuva injection to confirm maintained viral suppression 3
- Continue monitoring HIV-1 RNA according to standard guidelines for patients on long-acting injectable therapy 1, 2
Common Pitfalls to Avoid
Do not create a treatment gap by stopping Stribild days or weeks before the first Cabenuva injection, as this risks viral rebound and potential resistance development 1, 2
Do not assume that prior viral suppression on an INSTI-based regimen (Stribild contains elvitegravir) guarantees success with an NNRTI-based regimen (Cabenuva contains rilpivirine) without reviewing resistance history 2
Do not overlook the cobicistat component of Stribild when reviewing drug interactions, as patients may have been taking medications that required dose adjustments with cobicistat that will no longer be necessary after switching to Cabenuva 3, 4