Cabenuva Injection Interval
Cabenuva injections are administered either monthly (every 4 weeks) or every 2 months (every 8 weeks), depending on the dosing schedule selected at initiation. 1
Dosing Schedule Options
There are two FDA-approved regimens for Cabenuva:
Monthly Dosing Schedule
- Initiation dose: 600 mg cabotegravir + 900 mg rilpivirine on the last day of current antiretroviral therapy
- Maintenance doses: 400 mg cabotegravir + 600 mg rilpivirine every month (4 weeks) thereafter 1
Every-2-Month Dosing Schedule
- First two initiation doses: 600 mg cabotegravir + 900 mg rilpivirine given 4 weeks apart (on the last day of current ART, then 4 weeks later)
- Maintenance doses: 600 mg cabotegravir + 900 mg rilpivirine every 2 months (8 weeks) thereafter 1
The 2025 International Antiviral Society-USA guidelines align with this, recommending the first 2 injections separated by 4 weeks and subsequent injections by 8 weeks for the every-2-month schedule 2.
Clinical Evidence Supporting Both Schedules
The ATLAS-2M trial demonstrated non-inferiority of every-8-week dosing compared to every-4-week dosing, with virologic failure rates of 2% versus 1% respectively 3. Real-world data from the Spanish RELATIVITY cohort confirms excellent virologic suppression (>96%) and adherence with both schedules across diverse populations, including older adults and those with obesity 4, 5.
Managing Missed or Delayed Injections
Critical timing considerations:
- For monthly dosing: If injection is delayed ≥7 days, oral bridging therapy is recommended 2
- For every-2-month dosing: Similar oral bridging applies for delays ≥7 days
Reloading requirements (per IAS-USA guidelines):
- If injections are ≥8 weeks late from injection 2, or ≥16 weeks late from injection 3 onward, restart with two loading doses separated by 4 weeks before resuming the regular schedule 2
Key Clinical Pearls
- Both gluteal injections must be administered at each visit (cabotegravir and rilpivirine are separate injections) 1
- The choice between monthly and every-2-month dosing should be made collaboratively with the patient before initiating therapy 1
- Residual drug concentrations persist for up to 12 months or longer after the last injection, requiring careful planning when discontinuing 1