Apretude: The HIV PrEP Shot Every 2 Months Explained

Apretude (cabotegravir) is an injectable form of HIV PrEP — pre-exposure prophylaxis — given as a shot every two months instead of a daily pill. It's for HIV-negative adults and adolescents at risk through sex who weigh at least 77 pounds (35 kg) CDC, Talk PrEP Together. After an oral lead-in to confirm tolerance, you switch to long-acting injections.

The essentials: what Apretude is and isn't

PrEP is medicine that HIV-negative people take before a possible exposure to keep HIV from taking hold. Apretude delivers that protection as a long-acting injection rather than a pill you have to remember every morning. The active drug, cabotegravir, blocks an enzyme HIV needs to copy itself, so if the virus enters the body it can't establish an infection.

Apretude is one of three approved PrEP options. The other two are daily pills: Truvada, for people at risk through sex or injection drug use, and Descovy, for those at risk through sex only (Descovy isn't for people assigned female at birth who are at risk through receptive vaginal sex). Apretude is the injectable choice for people who'd rather not take a pill every day, approved for those at risk through sex who meet the weight threshold.

PrEP of any kind protects against HIV and nothing else. It doesn't prevent chlamydia, gonorrhea, syphilis, or any other STI, and it doesn't prevent pregnancy. People on Apretude still need condoms for other infections and routine STI screening, covered below.

How Apretude works

The drug works by keeping a protective level of cabotegravir in your blood at all times. With pills, you maintain that level by dosing daily. With Apretude, a single injection slowly releases medicine over weeks, so one shot covers the gap until the next.

Most people start with an oral lead-in, a short stretch of cabotegravir pills before the first injection. This confirms you tolerate the medicine before committing to a long-acting form you can't simply stop overnight. If the pills sit well with you, your clinician moves you to the shots.

Taken as prescribed, PrEP cuts the risk of getting HIV from sex by about 99%. For people who inject drugs, PrEP pills reduce risk by at least 74%, though Apretude itself is approved for sexual-exposure risk and not injection risk. Protection isn't instant. It takes about 7 days of consistent PrEP to reach maximum protection for receptive anal sex, and about 21 days for receptive vaginal sex and injection drug use. During that ramp-up window, keep using other prevention.

Practical details: the visit schedule and dosing

Apretude follows a different rhythm from a daily pill, so it helps to know the cadence going in.

• Negative HIV test first. You can't start any PrEP without confirming you're HIV-negative. Starting PrEP on an undiagnosed infection can lead to drug resistance.
• Oral lead-in (optional but common). A short course of cabotegravir pills to check tolerance before the first injection.
• The first injections. The early shots are spaced closer together to build up a protective level, then the schedule settles.
• Maintenance shots every two months. Once you're established, you come in for an injection every two months, given in the buttock by a clinician.
• Regular check-ins. At each visit you'll be retested for HIV and screened for other STIs, since PrEP doesn't cover them.

Starting PrEP in practice means that first HIV test and then regular check-ins for as long as you stay on it. Both in-person clinics and telehealth services can get you started, and patient-assistance programs exist to help cover the cost. Ask before you assume you can't afford it.

Apretude works only while a protective drug level is present, and that level fades after the dosing window passes. If you're going to be late, tell your clinic. There's a limited grace window, and if you fall outside it, your clinician may bridge you with oral PrEP or restart the lead-in. One late shot does not protect you indefinitely.

Apretude vs. daily PrEP pills

What Apretude does not cover

Apretude protects against HIV and nothing more. It does nothing for chlamydia, gonorrhea, syphilis, herpes, or HPV, and it offers no contraception. People on PrEP still pick up other STIs, so ongoing screening is built into the schedule. Plan to get tested regularly even when you feel fine, because many STIs cause no symptoms.

A common and dangerous mistake is treating PrEP like the morning-after pill. PrEP only works taken on an ongoing schedule, before exposure. If you've already had a single possible exposure and you're not on PrEP, that's a job for PEP — post-exposure prophylaxis — an emergency course started as soon as possible after the event CDC, Preventing HIV with PEP. PrEP and PEP are not interchangeable. If you're unsure how soon a test can pick anything up, see when to test after exposure.

PrEP also isn't the only tool. Condoms, fewer partners, and the fact that someone with HIV on effective treatment can't transmit it sexually all reduce risk. If you're weighing your choices, read about whether you can you prevent hiv without prep? and how earlier hiv treatment can help prevention across a community.

When to see a clinician

Book a visit if you're HIV-negative and have ongoing risk through sex — new or multiple partners, a partner whose status you don't know, or recent STIs — and you'd prefer a shot to a daily pill. Go sooner if you think you've already been exposed in the last few days, because that window favors PEP and it closes fast. And keep your appointments once you're on Apretude: a missed or badly late injection can quietly drop your protection.

Tell your clinician about any new symptoms — fever, rash, swollen glands, or flu-like illness after a possible exposure — since early HIV can look like that, and they'll want to confirm your status before your next shot.