Cabotegravir, the first long-acting injectable drug for HIV prevention, has been approved to be used in England and Wales. This development is expected to benefit approximately 1,000 individuals at risk of HIV, offering a long-acting alternative to existing preventive medications that must be taken daily as oral pills.
Cabotegravir is an antiretroviral medication that was initially developed for the treatment of HIV. These drugs are, however, now known to play a major role in lowering the chances of infection when administered to HIV-negative individuals. Cabotegravir functions by blocking the replication of the HIV virus inside human cells, which prevents the infection from establishing itself. This preventive method is referred to as pre-exposure prophylaxis (PrEP).
In contrast to oral PrEP, where individuals need to take it daily, injectable cabotegravir is administered through a single intramuscular injection into the buttocks at least once every two months by a skilled health care provider. Notably, cabotegravir is not a vaccine; it does not activate the immune system, but rather it provides a sufficient amount of drugs in the bloodstream to prevent HIV replication.
Cabotegravir is not a vaccine and does not stimulate the immune system. Unlike daily oral PrEP, which has a 99% efficacy with regular use, although its real-world efficacy is highly reliant on adherence. Cabotegravir injectable takes only six injections annually, making it easier to comply with. Research indicates that cabotegravir reduces the risk of HIV acquisition by 66% in gay men, bisexual men, and transgender women, and 88% in cisgender women, as compared to daily oral PrEP.
Nevertheless, injectable PrEP involves clinic visits twice a month to receive the injections, whereas oral PrEP users usually need prescription refills after every three or six months. These two types are safe and well-tolerated, though their side effects are different. Cabotegravir has the most prevalent side effect of injection site pain or swelling, whereas oral PrEP may cause nausea, vomiting, or headaches.
Recent recommendations suggest the use of cabotegravir among persons who do not take oral PrEP well. This covers individuals who have medical conditions such as severe liver or kidney disease and those who have difficulties in taking their pills daily, either socially or personally. As an example, homeless people, those who have unstable housing, those who are subjected to intimate partner violence, and those who use drugs may struggle to adhere to a pill regimen.
Cabotegravir had already been approved as a component in combination therapy among people living with HIV. It is also the first PrEP product to be made available to HIV-negative people who want protection, the first non-oral product in the NHS. The acceptance will open up access to some of the most effective preventive measures to individuals who were previously not able to take PrEP, and is also congruent with studies that indicate that a significant portion of the population prefers injectable prevention due to its convenience and minimal pill burden.
This approval may pave the way for the next generation of injectable PrEPs that need to be taken infrequently (once every six months) and are already on the market in the US. In spite of the achievements, there are still obstacles. The access to PrEP is unequal, where women constitute only 3% of current users but 35% of new HIV infections. This imbalance can be managed by options like adding injectables, which will increase the choice, but it will require sufficient funding for sexual health services. Moreover, community pharmacies and GP practices have the opportunity to offer PrEP, and this would increase its accessibility. Integrating injectable PrEP into these settings is essential to achieving the UK government’s goal of eliminating new HIV infections by 2030.
Reference: The Conversation. HIV prevention jab approved for use in England and Wales – here’s how it works. Published October 23, 2025. Accessed October 24, 2025. HIV prevention jab approved for use in England and Wales – here’s how it works
