What's the Difference Between Apretude and Cabenuva for HIV?

These days, people looking to prevent or treat HIV have a number of convenient, once-daily oral pill options to choose from. And even though these pills are safe and effective options for many people, they’re not ideal for everyone. 

Maybe you have a hard time swallowing pills. Or, perhaps, you don’t like having to think about taking medications every day. There’s also a chance you could be experiencing bothersome side effects from oral pills. 

If this sounds familiar, long-acting injectable medications may be a better option for you. In 2021, the FDA approved two new injectable medications for HIV — Apretude (cabotegravir) for prevention and Cabenuva (cabotegravir and rilpivirine) for treatment. 

Let’s take a closer look at these two new medications and how they compare. 

What is Apretude?

Apretude is a long-acting injectable medication that contains the HIV antiretroviral (ARV) medication cabotegravir. As of today, it’s the newest HIV ARV available on the market, and it’s the first injectable medication approved for HIV prevention. 

Is Apretude FDA-approved?

Currently, Apretude is approved for HIV prevention, commonly called pre-exposure prophylaxis (PrEP). With PrEP, people who don’t have HIV take medication to prevent an HIV infection. Apretude can be used for adults and adolescents who weigh at least 35 kg (77 pounds) and have a high risk for getting HIV through sex. 

What is Cabenuva?

Cabenuva is a combination of two different injectable medications. It contains cabotegravir, the same medication in Apretude. But it also contains a second HIV ARV medication, rilpivirine. 

Cabenuva is the first and only FDA-approved injectable that’s a complete HIV treatment regimen. Complete HIV treatment regimens contain at least two different kinds of HIV ARV medications. By using ARVs that work differently, the medications help your body attack HIV in multiple ways. 

However, Cabenuva isn’t the only injectable treatment option. Other injectables are available too. One option is Fuzeon (enfuvirtide), a twice-daily injection that’s sometimes used. Another option is Trogarzo (ibalizumab), a biweekly infusion for people with HIV that’s resistant to other medications. But unlike Cabenuva, these aren’t complete regimens by themselves. They are given with other medications. 

Is Cabenuva FDA-approved?

Cabenuva is FDA-approved for the treatment of HIV in adults. Yet, it’s not used for everyone who has HIV. Cabenuva should only be used if you have good viral suppression (a viral load of 50 copies/mL or less) on your current HIV regimen with no history of treatment failure and want to make the switch. There should also be no concerns with your body being resistant to either cabotegravir or rilpivirine. 

How do Apretude and Cabenuva work? 

Apretude and Cabenuva both contain cabotegravir, which is a type of integrase inhibitor. Integrase is an enzyme (protein) that the virus uses to enter your cells. When cabotegravir blocks integrase from working, HIV can’t enter your cells. This prevents it from making copies of itself and spreading. 

For HIV prevention, Apretude must be started before you’re exposed to HIV. That way, if you’re exposed to HIV during sex, it can work quickly to prevent the virus from spreading throughout your body and causing a chronic infection.

And since Cabenuva is used for treatment, it also contains rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI). Rilpivirine blocks reverse transcriptase, an enzyme that HIV needs in order to make copies of itself. 

Cabotegravir and rilpivirine work together to reduce the amount of HIV in your body. This also helps prevent the virus from becoming resistant to either medication. 

How are Apretude and Cabenuva dosed and given?

Apretude and Cabenuva are both injected into the muscle of your buttocks by a healthcare provider. However, they’re dosed slightly differently.

Apretude dosing

Each dose of Apretude is a 600 mg injection. The first two injections will be 1 month apart. But after the second injection, you’ll just get one dose every 2 months. 

But before you start receiving Apretude, you can choose to do something called an oral lead-in dose. This is like an optional trial period. An oral lead-in dose helps you test out the medications before starting a long-acting injection. It involves taking one 30 mg tablet of Vocabria (cabotegravir) daily for 1 month before getting your first injection.

Cabenuva dosing

Each dose of Cabenuva consists of two injections — one for cabotegravir and one for rilpivirine. This is because the medications don’t come together in the same vial or syringe. You can get these injections every 1 to 2 months.

For Cabenuva, the oral lead-in dose is a requirement before starting the injections. You would take one 30 mg tablet of Vocabria and one 25 mg tablet of rilpivirine daily for at least 1 month.

After you complete this oral lead-in, your first injections will contain 600 mg of cabotegravir and 900 mg of rilpivirine. If you’ll be getting your injections every month, each injection after that will contain 400 mg of cabotegravir and 600 mg of rilpivirine. But if you’ll be getting your injections every 2 months, you’ll continue to get the higher doses (600 mg of cabotegravir and 900 mg of rilpivirine).

Can you take Apretude and Cabenuva together for HIV?

No. Apretude and Cabenuva should never be taken at the same time. 

This is because they’re used for different purposes. Plus, both medications contain cabotegravir. Taking higher than recommended doses of cabotegravir raises the risk of unwanted side effects without providing much benefit. 

How effective are Apretude and Cabenuva for preventing and treating HIV?

Generally speaking, the FDA only approves new HIV treatments if researchers can show that the new medication is just as good — or better — than current standard treatment options. 

Prevention

For prevention, Apretude’s effectiveness has been measured in head-to-head studies with Truvada. Truvada (emtricitabine/tenofovir disoproxil fumarate) is a commonly used oral medication for PrEP. 

In one study, Apretude provided more protection than Truvada against HIV for men who have sex with men and for transgender women who have sex with men. 

There’s also an ongoing clinical trial comparing Apretude to Truvada in cisgender women, but the final results haven’t been published yet. However, early results suggest that Apretude works better than Truvada in this population as well. 

Treatment

For treatment, the FLAIR trial compared Cabenuva to Triumeq. Triumeq (abacavir/dolutegravir/lamivudine) is a tablet medication that’s a complete HIV regimen. In the study, after about 11 months, Cabenuva was shown to be similarly effective to Triumeq, which is a first-choice treatment option.

What are the known side effects of Apretude and Cabenuva?

Like all medications, Apretude and Cabenuva have a number of possible side effects. The most common side effects of both are reactions around the injection site, affecting over 80% of people in clinical trials. These reactions include symptoms like pain, redness, and swelling.

And while rare, some people may experience severe skin or allergic reactions with Apretude or Cabenuva. This is more likely to happen if you’ve had a severe reaction to a similar HIV ARV. Talk to your healthcare team if you have questions or concerns before starting these medications.

What interactions do Apretude and Cabenuva have?

Some medications interact with the breakdown of Apretude and Cabenuva in your body. These interactions can result in lower levels of cabotegravir. 

If cabotegravir levels are lower than expected, Apretude and Cabenuva won’t be as effective for preventing or treating HIV. For this reason, the following medications shouldn’t be taken at the same time as them:

• Carbamazepine (Tegretol)

• Oxcarbazepine (Trileptal)

• Phenobarbital

• Phenytoin (Dilantin)

• Rifampin

• Rifapentine (Priftin)

And since Cabenuva also contains rilpivirine, Cabenuva has a few more possible medication interactions than Apretude. For example, these additional interactions include rifabutin, dexamethasone (unless you’re only getting one dose), and St. John’s wort.

This isn’t a full list of possible medication interactions. As always, make sure your healthcare team has a full list of your medications so they can check for interactions. 

How much do Apretude and Cabenuva cost?

Apretude and Cabenuva are both newer medications, and neither medications have a generic version available. This means that they can be expensive. Their list prices are over $3,000 a dose. There may also be an additional fee for your healthcare provider to administer the medication to you. 

However, it’s difficult to predict your out-of-pocket cost for medications that are administered by a healthcare provider. This will also depend on your insurance coverage status. You can try calling your insurance company or talking to your HIV care team to get an estimate. 

There’s also a manufacturer-sponsored program called ViiVConnect that can provide personalized assistance. Call 1-844-588-3288 or visit ViiVConnect online for details. 

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Written by:

Hope Chang, PharmD, AAHIVP

Hope Chang is a freelance writer and content reviewer for GoodRx. She attended Howard University College of Pharmacy in Washington, D.C. and completed post-graduate residency training at the University of California, Davis Medical Center.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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