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.