Long-acting cabotegravir and rilpivirine in people with HIV receiving chronic anticoagulation: A real-world case series.

BACKGROUND: Long-acting intramuscular cabotegravir plus rilpivirine (LA-CAB + RPV) is an effective maintenance antiretroviral regimen for virologically suppressed people with HIV. However, its use in individuals receiving chronic anticoagulation is limited by concerns regarding intramuscular bleeding risk, and real-world data are scarce. METHODS: We conducted an observational, prospective, single-centre cohort study including all people with HIV (PVIH) who initiated LA-CAB + RPV at Hospital Clínic of Barcelona since February 2023 until April 2026. Patients receiving chronic anticoagulation during the follow-up were identified and assessed for safety and virological outcomes. RESULTS: Among 964 PVIH who started LA-CAB + RPV in our cohort, three were identified who received concomitantly chronic anticoagulation (direct oral anticoagulants or low-molecular-weight heparin). They received injections using standard deep intramuscular technique with post-injection compression. No clinically relevant injection-site hematomas or haemorrhagic complications were observed. Viral suppression was maintained in all cases. CONCLUSIONS: This real-world case series suggest that chronic anticoagulant therapy alone should not automatically preclude the use of LA-CAB + RPV. With careful patient selection and appropriate injection techniques, LA-CAB + RPV may represent a safe and effective treatment option for selected people with HIV receiving anticoagulation.