Long‐acting cabotegravir and rilpivirine in people with HIV and cancer: Virological eligibility and DDI considerations

Aims To assess the potential applicability of long‐acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) in people with HIV (PWH) and cancer by evaluating clinical conditions potentially limiting oral ART, eligibility according to current prescribing criteria, and pharmacological suitability in relation to anticancer therapies. Methods We conducted a retrospective single‐centre study including PWH diagnosed with cancer between September 2022 and December 2025. Among ART‐experienced patients, theoretical candidacy for LAI CAB/RPV was evaluated by assessing clinical conditions potentially compromising oral ART, regulatory eligibility and pharmacological suitability based on predefined drug‐drug interactions (DDI) scenarios with anticancer therapies. Results Among 168 PWH with cancer, 154 were ART‐experienced. Clinical conditions potentially affecting oral ART were identified in 59 patients (38.3%). After excluding 12 patients, 111/142 (78.2%) met current prescribing criteria for LAI CAB/RPV. Pharmacological assessment identified three red‐flag and 27 orange‐flag DDIs, mainly involving rilpivirine. Pharmacological suitability was retained in 108/111 (97.3%) patients under a permissive scenario (red‐flag DDIs only) and in 84/111 (75.7%) under a conservative scenario (red‐ and orange‐flag DDIs). Conclusions Most ART‐experienced PWH with cancer were eligible for LAI CAB/RPV, while many had conditions potentially limiting oral ART. Candidate selection should integrate clinical need, virological eligibility, pharmacological assessment and patient‐related factors through a multidisciplinary approach.