Ultrasound for the determination of appropriate needle length for intragluteal injection of long-acting rilpivirine–cabotegravir

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2026-09-06 Epub Date: 2026-06-22 DOI:10.1111/hiv.70272

Candice Gueuning, Mrishta Brizmohun, Nicolas Dauby, Charlotte Martin

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引用次数: 0

Abstract

Objectives

Long-acting (LA) intramuscular injections of cabotegravir (CAB) and rilpivirine (RPV) are an effective maintenance therapy for people living with HIV who are virologically suppressed. However, virological failures (VFs) have been reported, often associated with elevated body mass index (BMI), potentially due to inadequate intramuscular drug delivery. Current recommendations mainly rely on BMI to guide needle length selection and do not routinely incorporate imaging techniques. Furthermore, they do not recommend the use of ultrasound as an investigative tool in cases of LA treatment failure.

Methods

We retrospectively reviewed anonymized records of two patients experiencing virological rebound under LA CAB/RPV. Clinical, virological and resistance data were extracted from their medical records.

Results

The first case involves an obese patient. Ultrasound revealed subcutaneous adipose tissue thickness >3 cm and intra-adipose injection granulomas, suggesting non-intramuscular injections. After adapting needle length, virological suppression was restored. The second case involves a patient with a normal BMI in whom ultrasound revealed a gluteal subcutaneous adipose tissue thickness of 45 mm and bilateral subcutaneous granulomas.

Conclusion

Ultrasound is a simple and accessible tool to help optimize drug injection in case of obesity or gynoid fat distribution and investigate injection technique–related issues in cases of VF.

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超声确定长效利匹韦林-卡博特韦腹腔注射合适针长。

目的：长效（LA）肌肉注射卡博特重力韦（CAB）和利匹韦林（RPV）是一种有效的维持治疗HIV感染者谁是病毒学抑制。然而，已有病毒学失败（VFs）的报道，通常与体重指数（BMI）升高有关，可能是由于肌肉内给药不足。目前的建议主要依靠BMI来指导针头长度的选择，而不是常规地结合成像技术。此外，他们不建议在LA治疗失败的情况下使用超声作为调查工具。方法：我们回顾性地回顾了在LA CAB/RPV下经历病毒学反弹的两例患者的匿名记录。从他们的医疗记录中提取临床、病毒学和耐药性数据。结果：第一例为肥胖患者。超声示皮下脂肪组织厚度约3cm，脂肪内注射肉芽肿，提示非肌内注射。调整针头长度后，恢复病毒学抑制。第二例患者BMI正常，超声显示臀皮下脂肪组织厚度45mm，双侧皮下肉芽肿。结论：超声是一种简单易行的工具，可以帮助肥胖或女性脂肪分布的患者优化药物注射，并探讨VF患者的注射技术相关问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.