Should the Patient Continue Descovy Until After the Second Apretude Injection?
Yes, the patient should continue daily Descovy for 7 days after the first Apretude (cabotegravir) injection to ensure adequate HIV protection while cabotegravir reaches therapeutic levels. 1
Rationale for Oral PrEP Overlap
The most recent 2024 International Antiviral Society-USA guidelines explicitly address this clinical scenario:
A 7-day overlap with oral PrEP is recommended after the first cabotegravir injection to allow time for maximal protection from long-acting cabotegravir. 1
For patients transitioning from tenofovir-based oral PrEP (like Descovy) to injectable cabotegravir, continuation of the tenofovir-based regimen is specifically recommended for this overlap period. 1
The timing of onset of protection from cabotegravir is unknown but is estimated to be approximately 7 days after the first injection, hence the need for bridging therapy. 1
Practical Implementation
After the 7-day overlap following the first injection:
The patient can discontinue Descovy once the 7-day period is complete. 1
The second injection should occur 4 weeks after the first injection (this is the standard "loading" schedule). 2, 1
The patient does NOT need to continue Descovy until the second injection — only for 7 days after the first. 1
Important Contingency Planning
The patient should keep a 1-month supply of Descovy on hand for oral bridging in case of injection delays of 7 days or more beyond scheduled appointments. 1 This is a critical safety measure to maintain continuous HIV protection if clinic visits are missed or delayed.
Common Pitfall to Avoid
Do not confuse the oral lead-in period (which is optional and occurs before the first injection) with the post-injection overlap period (which is recommended and occurs after the first injection). 1 The 7-day overlap with tenofovir-based PrEP after the first injection is distinct from and independent of whether an oral cabotegravir lead-in was used. 1