Long-Acting Injectable Antiretrovirals: Pharmacology for Treatment and Prevention

This narrative review synthesizes the clinical pharmacology, efficacy, and pregnancy/breastfeeding data for injectable cabotegravir, rilpivirine, and lenacapavir, with practical dosing and monitoring implications relevant to women's health pharmacists.

cabotegravirrilpivirinelenacapavirlong-acting injectable antiretroviralsHIV treatmentHIV pre-exposure prophylaxispregnancybreastfeedingpediatricspharmacokineticstherapeutic drug monitoringintegrase strand transfer inhibitorcapsid inhibitorNNRTInarrative review Women's Health / Reproductive

Background Information

Long-acting antiretrovirals transform HIV management and prevention for women.

Long-acting antiretroviral therapies reduce daily pill burden and improve adherence, particularly benefitting women, including pregnant and breastfeeding individuals, by sustaining virologic suppression and preventing transmission. The review focuses on cabotegravir, rilpivirine, and lenacapavir, exploring pharmacokinetics, patient-specific considerations, and real-world application for improved patient care. This analysis underscores the need for research in understudied groups such as pregnant and breastfeeding women, while recognizing the potential of long-acting injectables for broader preventive use. Long-acting injectable antiretrovirals offer promising adherence solutions in HIV care, but further research is necessary for optimal use in diverse populations.

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Authors: Dunbar A, Rakhmanina N, Unternaher J, Anderson PL, Brooks KM

Citation: Dunbar A, Rakhmanina N, Unternaher J, et al. Long-Acting Injectable Antiretroviral Therapies for HIV Treatment and Prevention: Clinical Pharmacology, Recent Advances and Future Opportunities. Journal of clinical pharmacology. 2026;66(8):e70249. doi:10.1002/jcph.70249

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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