Long-acting injectable antiretroviral drugs are a paradigm shift in the treatment and prevention of HIV infection by eliminating the need of daily medication. However, real-world data have revealed substantial pharmacokinetic (PK) variability, challenging the one-size-fits-all dosing approach.
Key factors affecting long-acting antiretrovirals exposure after intramuscular administration were identified, including bodyweight, sex, as well as significant intra- and inter-individual variability in absorption and elimination. In particular, model-based simulations highlighted sex-related differences in cabotegravir PK: females had lower trough concentrations at treatment initiation but significantly higher levels during the late maintenance phase. These findings have direct clinical implications, particularly for individuals with additional risk factors – such as obesity – who may benefit from individualized TDM where feasible.
This presentation will explore how population pharmacokinetic (popPK) modelling and TDM can refine dosing strategies for long-acting antiretrovirals by tailoring dosing intervals based on individual PK data. It will discuss the integration of popPK models and Bayesian approaches into routine clinical practice, aiming to optimize drug exposure, minimize the risk of under-exposure, and sustain virologic suppression while reducing treatment burden.