From the Guidelines
Cabenuva (long-acting injectable cabotegravir and rilpivirine) can typically be continued through the perioperative period for spine surgery. There is no need to discontinue this HIV medication regimen before, during, or after surgery as it does not increase bleeding risk or interact significantly with most anesthetics. Since Cabenuva is administered monthly or every two months via intramuscular injection, patients maintain stable drug levels throughout the perioperative period, which helps ensure continuous HIV suppression. If the patient's scheduled Cabenuva injection falls during the immediate perioperative period, it can usually be administered a few days earlier or later without compromising efficacy. However, the surgical team should be informed about the patient's Cabenuva regimen to ensure coordination with other medications. Unlike oral antiretrovirals that might be difficult to take during NPO (nothing by mouth) periods or with postoperative nausea, Cabenuva's injectable format eliminates these concerns, making it particularly advantageous during surgical periods. As with any medication during surgery, the anesthesiologist should be made aware of all current medications to monitor for any rare drug interactions, as recommended by recent guidelines 1. The continuation of Cabenuva during the perioperative period is supported by its pharmacokinetic properties and the lack of significant interactions with anesthetics, allowing for uninterrupted HIV treatment and minimizing the risk of viral resistance or disease progression 1.
From the Research
Continuing Cabenuva through Perioperative Period for Spine Surgery
- There is no direct evidence in the provided studies to support or refute the continuation of Cabenuva through the perioperative period for spine surgery.
- The studies primarily focus on the efficacy, safety, and pharmacokinetics of Cabotegravir and Rilpivirine for the treatment of HIV infection 2, 3, 4, 5, 6.
- However, it is essential to consider the potential interactions between Cabenuva and other medications used during the perioperative period, as well as the impact of surgery on the pharmacokinetics of Cabotegravir and Rilpivirine.
- The decision to continue or discontinue Cabenuva during the perioperative period should be made on a case-by-case basis, taking into account the individual patient's medical history, the type of surgery, and the potential risks and benefits of continuing or discontinuing the medication.
Key Considerations
- The studies suggest that Cabotegravir and Rilpivirine have a favorable safety profile and high rates of sustained virologic suppression in patients with HIV infection 2, 3, 5.
- The long-acting nature of Cabenuva may provide an advantage in terms of adherence and convenience, particularly in patients who may have difficulty taking daily oral medications 4, 6.
- However, the potential risks and benefits of continuing Cabenuva during the perioperative period must be carefully weighed, and patients should be closely monitored for any adverse effects or interactions with other medications.