What is Apretude?
Apretude (long-acting cabotegravir or CAB-LA) is a prescription long-acting injectable medication used for HIV pre-exposure prophylaxis (PrEP). It's administered by a healthcare provider as an intramuscular injection into the gluteal (buttock) muscle every two months. It's FDA-approved as a PrEP option.
How is Apretude Administered?
Intramuscular (IM) injection into the buttock by a healthcare provider.
Starting Treatment
- Optional Oral Lead-In
- Some individuals may start with 30mg oral cabotegravir once daily for 30 days to assess tolerance.
- First Injection (Loading Dose):
- After the optional oral lead-in or directly, you’ll receive your first 600mg injection (3mL) into the gluteal muscle (buttock).
- Second Injection (Follow up Dose):
- Given 1 month after your first injection
Ongoing Treatment
- Every 2 months
- After the first two injections, you’ll receive a dose every 2 months on a “target” date.
- These are called “maintenance injections” and are key to staying protected
It's crucial to receive injections within a 7-day window of the scheduled date to maintain effectiveness. That means 7 days before or 7 days after your target date.
Safety and Side Effects
- Before starting Apretude, you must test HIV-negative. Some tests may not detect very recent infections, so let your provider know if you’ve had flu-like symptoms in the past month (e.g., fever, fatigue, muscle aches, sore throat, swollen lymph nodes, rash, night sweats). These could be early signs of HIV.
- Apretude protects against HIV, but not other STIs like gonorrhea, chlamydia, or syphilis. Using condoms and regular STI testing are still recommended.
- Adherence: Missing or delaying injections can lead to low drug levels, which increases the risk of getting HIV and may cause the virus to become resistant to medication. Always attend your injection appointments on time and talk to your care team if you’re running late or need to reschedule.
- Drug Interactions: Tell your provider about all medications, vitamins, and supplements you take. Certain drugs — including rifampin, rifapentine, phenytoin, phenobarbital, and carbamazepine — can interfere with how Apretude works and may make it less effective.
Common Side Effects
- Injection site reactions: pain, swelling, redness, warmth, bruising, itching, tenderness, lumps, numbness, or skin discoloration
- Fatigue, fever, headaches
- Nausea, diarrhea
- Dizziness, insomnia
- Weight gain (uncommon)
Rare but Serious
- Liver injury (hepatotoxicity)
- Severe muscle breakdown (rhabdomyolysis)
- Even with perfect use, HIV infection is still possible in rare cases
- Allergic reactions – seek emergency help for rash, fever, mouth sores, difficulty breathing, or swelling of the face, lips, or tongue
Who Should Consider Apretude?
Apretude may be a good option if you:
- Can adhere to the every-2-month injection schedule.
- Engage in behaviors that increase the risk of HIV, such as having sexual partners of unknown HIV status or inconsistent condom use.
- Anyone who may be at risk due to other factors that might increase their chances of coming into contact with HIV.
- Have no contraindications or drug interactions
Who Should Not Receive Apretude?
Apretude may not be right for everyone. Do not use Apretude if you:
- Have a known allergy to cabotegravir or other similar medications.
- Are HIV-positive or your HIV status is unknown.
- Apretude is for HIV prevention only. If you already have HIV and take Apretude alone, it can lead to drug resistance, making HIV harder to treat.
- Engage in injecting drug use
- Have known liver problems
- Take certain medications that reduce Apretude’s effectiveness, including:
- Carbamazepine
- Oxcarbazepine
- Phenobarbital
- Phenytoin
- Rifampin
- Rifapentine
- Cannot reliably attend injection appointments every 2 months or complete regular lab testing.
Missed Doses
Staying on schedule is very important to keep Apretude working effectively. Here’s what to do if you miss or expect to miss a dose:
Planned Misses (e.g., Travel, Scheduling Conflicts)
If you know in advance that your injection will be more than 7 days late, your Freddie clinician can help by prescribing oral cabotegravir (CAB) pills as a temporary alternative.
- Oral CAB can replace one missed injection for up to 2 months
- If your delay will be longer than 2 months, you’ll need to switch to a different form of oral PrEP (like Descovy or Truvada)
- The first oral PrEP pill should be taken 2 months after your last Apretude injection
- Resume injections on the last day of the pills or within 3 days after.
Unplanned Misses
Didn’t make it to your appointment on time? Here's what to expect:
- If it’s been less than 1 month since your missed injection date:
- You can resume injections and stay on the usual every 2-month schedule.
- If it’s been more than 1 month since your missed injection date:
- You’ll need to restart Apretude with:
- Two loading doses, 1 month apart
- Then resume injections every 2 months
- You’ll need to restart Apretude with:
If You Stop Injections
- If you stop receiving injections, you must switch to daily oral PrEP for 10 months.
- This is important because Apretude remains in your system at low levels but won’t fully protect you.
- Failure to do this can lead to resistance to HIV medication, making future treatment more difficult.
Lab Testing & Monitoring
Baseline labs are done prior to starting Apretude:
- HIV test
- Syphilis
- Gonorrhea and chlamydia (urine)
- Kidney function (Creatinine and GFR)
- Hepatitis B
Follow up labs are done every 2 months, just before or at the time of injection.
- HIV test
- Syphilis
- Gonorrhea and chlamydia (urine)
- Rectal and Throat swabs can also be provided
- Kidney function (Creatinine and GFR)
Cost and Insurance
- Apretude is a brand-name drug, which may be expensive without insurance.
- Your Apretude provider will help by submitting your insurance information to check if you qualify for coverage.
- If not covered, a provider will help you start or continue oral PrEP as an alternative.