Long-Acting Cabotegravir and Rilpivirine Treatment for HIV in Patients With Kidney Failure: Two Cases of Successful Transition to Long-Acting Injectable HIV Therapy

Kidney disease is common in people with HIV and certain antiretroviral therapies can be nephrotoxic. Cabotegravir and rilpivirine is the first long-acting injectable regimen for treatment of HIV. Clinical trials for long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) for HIV treatment did not include patients with kidney failure, though this combination is typically regarded as non-nephrotoxic. In addition, dialysis is not expected to alter LA-CAB/RPV pharmacokinetics. Polypharmacy is common in patients with kidney failure and HIV who are often prescribed medications that interact with oral antiretroviral therapy and may benefit from an injectable regimen. We present 2 patients with kidney failure treated with hemodialysis whose HIV was treated with LA-CAB/RPV. Both patients maintained viral suppression after transition to LA-CAB/RPV, with good tolerability, including one patient who underwent kidney transplant. These cases highlight the promise of LA-CAB/RPV for patients with HIV and kidney failure, and the need for inclusion of patients requiring dialysis in trials of new antiretroviral therapy modalities.