Abstract

The ongoing HIV epidemic disproportionately affected adolescent and young adult populations worldwide, 
underscoring the urgent need for effective prevention strategies. Long-acting injectable cabotegravir (CAB-LA) has 
emerged as a novel pre-exposure prophylaxis (PrEP) modality designed to overcome adherence challenges 
associated with daily oral regimens. This review synthesized recent literature on CAB-LA’s molecular mechanisms, 
clinical efficacy, safety, and adherence patterns specifically in adolescents and young adults. A systematic literature 
search of PubMed, Embase, and Web of Science was conducted for studies published from 2017 to 2025 using 
keywords including "cabotegravir," "long-acting PrEP," "adolescents," "young adults," and "HIV prevention." 
Evidence demonstrated that CAB-LA inhibits HIV integration via integrase strand transfer inhibition, with clinical 
trials showing superior efficacy compared to daily oral tenofovir/emtricitabine in preventing HIV acquisition in 
high-risk youth. CAB-LA’s extended dosing interval (every two months) improved adherence and persistence, 
critical factors in this demographic facing stigma and pill fatigue. Safety profiles were favorable, with minimal 
injection site reactions and no adverse effects on bone mineral density. Notwithstanding, mental health 
considerations and tailored counseling remain essential for optimizing outcomes. Despite promising efficacy, 
challenges persisted regarding long-term safety data, cost-effectiveness, and ensuring equitable access. In 
conclusion, long-acting cabotegravir offers a transformative HIV prevention tool in adolescents and young adults, 
with adherence advantages that could markedly reduce HIV incidence in this vulnerable group. Further pragmatic 
studies and implementation research are needed to address outstanding gaps and maximize population health impact.