Academy Exchange

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  • 1.  Cabenuva

    Posted 06-19-2024 18:03

    I have a 40 y/o female currently on Odefsey, undetectable, who wants to switch to Cabenuva. She would be ideal candidate, however, the patient mentioned she is interested and seeking IVF for pregnancy. I counseled that we shouldn't switch ART and no studies known about pregnancy and Cabenuva, but she insists and says she will switch to a recommended regimen if/when pregnant and go back to Cabenuva after she gives birth. Any advice if moving forward at her insistence. She is not pregnant now



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    Elizabeth Horvath
    Avenue360 Health & Wellness
    Houston TX
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  • 2.  RE: Cabenuva

    Posted 30 days ago

    Neither is a preferred regimen in the perinatal guidelines, but of course there's more clinical experience with Odefsey.

    Switching off Cabenuva after pregnancy wouldn't make sense, because she'd maintain concentrations of both CAB and RPV for well over 9 months. And guidelines state that switching ART can be done in anticipation of pregnancy, but once a woman is pregnant she can be left on her current regimen.



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    Joel Gallant, MD, MPH
    Santa Fe, NM
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  • 3.  RE: Cabenuva

    Posted 30 days ago

    If she wants to make the switch with the awareness that there's no data in pregnancy, I would support that (and add her data to the antiretroviral pregnancy registry if/when she gets pregnant) but would also reiterate what Dr. Gallant pointed out about CAB/RPV sticking around in the body for a long time. The perinatal HIV guidelines state "for those who are considering switching regimens prior to conception to prevent fetal exposure, it is important to recognize that CAB and RPV injections must be stopped at least one year before conception to ensure these long-acting drugs are fully eliminated." (Emphasis mine) This may be reasonable for her or maybe it's something she doesn't know yet about the medications that might cause her to reconsider. 



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    Lealah Pollock, MD MS
    UCSF, National Clinician Consultation Center, Perinatal HIV Hotline
    San Francisco CA
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  • 4.  RE: Cabenuva

    Posted 29 days ago
    Edited by Brooke Darmstadter 29 days ago

    I agree with Dr Gallant's info and also think it would be important to make sure she knows that a BMI>30 is one of the risk factors for Cabenuva treatment failure. During pregnancy, the volume of distribution increases, which results in the need for dose increases of certain medications. I haven't seen any data about appropriate dosing of Cabenuva in pregnancy. If this regimen fails during pregnancy, you run the risk of transmission to the baby. As a mother, this is information I would want to have prior to making the decision to use Cabenuva. 



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    Brooke Darmstadter, PharmD, AAHIVP
    Georgetown DE
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  • 5.  RE: Cabenuva

    Posted 26 days ago

    There is a nice case report about CABENUVA in pregnant woman in CID that was published in May 2024. 

    Lena van der Wekken-Pas, Fabian Weiss, Charlotte Simon-Zuber, Rena Sebisch, Carmen Wiese, Elisabeth van Leeuwen, David Burger, Angela Colbers, Long-Acting Injectable Cabotegravir and Rilpivirine in a Pregnant Woman Living With Human Immunodeficiency Virus, Clinical Infectious Diseases, 2024;, ciae242, https://doi.org/10.1093/cid/ciae242

    Author does worry that RPV level may not be adequate if CABENUVA is given every 2 months and suggest, if have to continue CABENUVA, monthly dosing is preferred. 



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    Chiu-Bin Hsiao, MD, FIDSA, AAHIVS
    Allegheny General Hospital - Positive Health Clinic
    Pittsburgh PA
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