Mark Watkins, DO, an HIV provider at Philadelphia’s Mazzoni Center, has been treating people with HIV since there were first pills for it. And one thing he’s learned as treatment has gotten simpler is, “It doesn’t matter if it’s five pills or one pill, if you’re not in the habit of taking pills every day, you’re going to have an issue.”
So for young people living with HIV, long-acting injectable Cabenuva (cabotegravir/rilpivirine) may hold extra promise—the promise of not needing to learn how to take a pill every day, the way generations of people living with HIV have before them. But it’s not as simple as just signing up for a shot.
Here are things to consider before you make the switch:
- Right now, Cabenuva is approved for people living with HIV who already have undetectable viral loads. So your first treatment will still have to be pills—at least at first. Talk to your doctor about how their office can support you to get to undetectable and stay there.
- Before you can take a shot monthly, you have to take two pills a day for a month. While the shots could be a game-changer for young people living with HIV who aren’t used to the routine of pill taking, learning to do it successfully is still the first step in starting on monthly shots. The two drugs in Cabenuva, cabotegravir and rilpivirine, are safe and free of the side effects early HIV meds had. But that doesn’t mean they agree with everyone. That’s why there’s a month-long lead-in period with the two drugs by pill before you can get your shot. If it doesn’t agree with you, your doctor will switch you back to another regimen that does. But don’t fret—researchers are currently developing other drugs for long-term injection, so other opportunities will likely come your way.
- Can you take off work or school to get to the doctor every month? The good news is the shot is just every 28 days; the bad news is that you have to get to the doctor’s office every month to get it. Right now, Cabenuva is not available at your local pharmacy. So you have to think about the logistics: Do you have the time and transportation to get to your doctor’s office every month?
- Are you afraid of shots? Of course, getting a month-long injection of HIV treatment means you have to be willing to get a shot—two shots, in fact. They go right into your hip muscles, to be released slowly over the month.
- Are you concerned about others seeing your pill bottles? For many young people, having a pill bottle around is difficult—especially if they live in a house with multiple people, or live at home with extended family. If you do, and you are self-conscious about others seeing you take a pill or just don’t want to answer questions about why you’re taking a pill, a monthly injection could be for you.
“Some people have said to me, ‘I don’t like needles,’” Watkins said. “No problem. This isn’t for you, then. That’s why Baskin Robbins made 31 different flavors of ice cream—because not everybody likes butter pecan.”