This article was updated 10/28/2025 at 10am to correct the brand name of cabotegravir for prevention of HIV. It is Apretude, not Cabenuva. We regret the error.
With two long-acting injectables for HIV on the market, how do you choose which one to administer to patients? A new study at EACS 2025, in Paris, has found that patients and providers alike overwhelmingly preferred cabotegravir (Apretude, ViiV Healthcare) over lenacapavir (Yeztugo, Gilead), mainly due to better tolerability and fewer injection site reactions (ISRs) with cabotegravir.
“These initial findings underscore the importance of individual choice and informed decision-making in choice of long-acting injectable HIV therapy or prevention options. While it’s a relatively small study, CLARITY adds to the growing body of clinical and real-world evidence for [cabotegravir] demonstrating efficacy, safety, and tolerability,” a ViiV spokesperson told Infectious Disease Special Edition.
A Crossover Design
In the study (abstract MeP20.4.LB), which was undertaken by researchers from ViiV Healthcare and its parent company GSK, patients who did not have HIV (N=64) were randomized to first receive cabotegravir or lenacapavir on first dose and then cross over to receive the other study drug on the second dose. One participant in the lenacapavir-to-cabotegravir arm withdrew before receiving any doses. The researchers assessed tolerability using the Perception of Injection questionnaire seven days after each injection, and both healthcare providers (HCPs; n=7) and study participants (n=60) also answered questionnaires about drug preference. The researchers also collected data on additional end points, including investigator-assessed ISR incidence, severity, duration, and imaging through a six-month follow-up.
Choosing Cabotegravir
After receiving both injections, more patients said they found the cabotegravir injections to be acceptable than lenacapavir (75% “totally” or “very acceptable” with cabotegravir vs. 57% with lenacapavir), and both patients and HCPs overwhelmingly said they preferred the cabotegravir injections over lenacapavir (cabotegravir, 90% participants and 86% HCPs vs. lenacapavir, 10% participants and 14% HCPs).
In addition, the researchers said ISRs with lenacapavir were more frequent than with cabotegravir (540 vs. 117, respectively), and more visible ISRs were seen with lenacapavir than cabotegravir in every metric (induration, 86% vs. 21%; nodules, 74% vs. 18%; erythema, 58% vs. 10%; and swelling, 57% vs. 34%).
According to the researchers, data such as this are important in helping participants choose the medication that will work best for them. “These data are important in empowering individuals and their HCPs to make fully informed decisions regarding LAI [long-acting injectable] antiretrovirals,” they wrote.
“We believe long-acting innovations will play a critical role in the global response to ending HIV and AIDS, and understanding potential differences in acceptability and tolerability of different options is an important consideration when choosing between long-acting injectables,” the spokesperson told IDSE.
The researchers are employees of ViiV Healthcare and its parent company GSK.