Cabotegravir for preventing HIV-1 in adults and young people

Long-acting injectable cabotegravir (CAB-LA) is an integrase strand-transfer inhibitor (INSTI) that is administered as an intramuscular injection into the gluteus muscle.

There is trial evidence that CAB-LA was superior to daily oral tenofovir disoproxil fumarate–emtricitabine (TDF–FTC) in preventing HIV acquisition among MSM and transgender women who have sex with men (1):

• compared the safety and efficacy of CAB-LA with that of TDF–FTC for the prevention of HIV infection in MSM and transgender women who have sex with men
• found that the risk of HIV infection was lower by 66% in the cabotegravir group than in the TDF–FTC group in the prespecified analysis, a result that showed the superiority of CAB-LA to TDF–FTC

NICE state that (2):

• cabotegravir is recommended as an option for pre-exposure prophylaxis (PrEP) alongside safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults and young people at high risk of getting HIV and who weigh at least 35 kg, only if:
  • they cannot have oral PrEP
  • cabotegravir is purchased at the Medicines and Procurement Supply Chain framework price

The NICE committee note that:

"..People at high risk of getting HIV can reduce their risk by taking daily PrEP tablets (oral PrEP). But some people cannot have oral PrEP. Cabotegravir is a long-acting injection for PrEP that is used every 2 months, after initiation injections...Evidence from clinical trials and indirect comparisons suggests that cabotegravir reduces the risk of getting HIV more than oral PrEP or no PrEP.."

Reference:

1. Landovitz RJ et al;HPTN 083 Study Team. Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women. N Engl J Med. 2021 Aug 12;385(7):595-608.
2. NICE (November 2025). Cabotegravir for preventing HIV-1 in adults and young people.