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The following indications for CABOTEGRAVIR ER (CABENUVA) (cabotegravir) have been approved by the FDA:
Indications:
HIV infection pre-exposure prophylaxis
HIV infection
Professional Synonyms:
HIV infection prevention before exposure
Human immunodeficiency virus disease
Human immunodeficiency virus infection
Pre-exposure prophylaxis
Indications:
HIV infection pre-exposure prophylaxis
HIV infection
Professional Synonyms:
HIV infection prevention before exposure
Human immunodeficiency virus disease
Human immunodeficiency virus infection
Pre-exposure prophylaxis
The following dosing information is available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
Available orally as cabotegravir sodium; dosage expressed in terms of cabotegravir.
Cabotegravir sodium (Vocabria(R)) is administered orally as tablets. Cabotegravir extended-release injectable suspension (Apretude(R)) is administered by IM injection.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| CABOTEGRAVIR ER 600 MG/3 ML VL | Maintenance | Adults inject 3 milliliters (600 mg) by intramuscular route every 2 months |
| CABOTEGRAVIR ER 400 MG/2 ML VL | Maintenance | Adults inject 2 milliliters (400 mg) by intramuscular route once a month |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| CABOTEGRAVIR ER 600 MG/3 ML VL | Maintenance | Adults inject 3 milliliters (600 mg) by intramuscular route every 2 months |
| CABOTEGRAVIR ER 400 MG/2 ML VL | Maintenance | Adults inject 2 milliliters (400 mg) by intramuscular route once a month |
The following drug interaction information is available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Cabotegravir/UGT1A1 Inducers SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Carbamazepine, efavirenz, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone, rifapentine, rifampin, and ritonavir may induce the metabolism of cabotegravir by uridine diphosphate (UDP)-glucuronosyl transferase 1A1 (UGT1A1).(1) CLINICAL EFFECTS: Concurrent or recent use of carbamazepine, efavirenz, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone, rifapentine, rifampin, or ritonavir may result in decreased levels and effectiveness of cabotegravir, as well as the development of resistance.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of cabotegravir states that concurrent use of UGT1A1 inducers such as carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone, rifapentine, rifampin, and ritonavir is contraindicated.(1) It may take several weeks after the discontinuation of an enzyme inducer for enzyme activity to return to normal.(1) DISCUSSION: In a study in 15 subjects, rifampin (600 mg daily) decreased the concentration maximum (Cmax), area-under-curve (AUC), and concentration minimum (Cmin) of cabotegravir by 6%, 59%, and 50%, respectively.(1) UGT1A1 inducers linked include: carbamazepine, efavirenz, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone, rifapentine, rifampin, and ritonavir.(1,2) |
CARBAMAZEPINE, CARBAMAZEPINE ER, CARBATROL, CEREBYX, DILANTIN, DILANTIN-125, DONNATAL, EFAVIRENZ, EFAVIRENZ-EMTRIC-TENOFOV DISOP, EFAVIRENZ-LAMIVU-TENOFOV DISOP, EPITOL, EQUETRO, FOSPHENYTOIN SODIUM, KALETRA, LOPINAVIR-RITONAVIR, MYSOLINE, NORVIR, OXCARBAZEPINE, OXCARBAZEPINE ER, OXTELLAR XR, PAXLOVID, PHENOBARBITAL, PHENOBARBITAL SODIUM, PHENOBARBITAL-BELLADONNA, PHENOBARBITAL-HYOSC-ATROP-SCOP, PHENOHYTRO, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED, PRIFTIN, PRIMIDONE, RIFADIN, RIFAMPIN, RITONAVIR, SEZABY, SYMFI, TEGRETOL, TEGRETOL XR, TRILEPTAL |
There are 5 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Intramuscular Cabotegravir/Rifabutin SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Rifabutin may induce the metabolism of cabotegravir by CYP3A4.(1,2) CLINICAL EFFECTS: Concurrent or recent use of rifabutin may result in decreased levels and effectiveness of cabotegravir.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The implications of this interaction differs depending on the indication for cabotegravir. If cabotegravir is used with rilpivirine for treatment of HIV infection: - Rifabutin should be avoided.(1) If cabotegravir is used alone for pre-exposure prophylaxis: - In a patient already on or just starting rifabutin, increase the frequency of cabotegravir doses to 600 mg every 2 weeks for the first 2 doses, then 600 mg monthly thereafter while on rifabutin. - In a patient starting rifabutin after the second injection or later of cabotegravir, increase cabotegravir injections to 600 mg monthly while on rifabutin. After stopping rifabutin, the recommended dosing schedule of cabotegravir is 600 mg every 2 months.(2) DISCUSSION: Coadministration of rifabutin (300 mg once daily) with cabotegravir (30 mg once daily) decreased cabotegravir's area-under-the-curve (AUC), minimum concentration (Cmin), and maximum concentration (Cmax) by 23%, 26%, and 17%.(1,2) |
RIFABUTIN, TALICIA |
| Betibeglogene Autotemcel/Anti-Retrovirals; Hydroxyurea SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Betibeglogene autotemcel is prepared from apheresed cells that are transduced with a replication defective, self-inactivating lentiviral vector. Antiretrovirals may interfere with the manufacturing of apheresed cells. Hydroxyurea may interfere with hematopoietic stem cell (HSC) mobilization of CD34+ cells.(1) CLINICAL EFFECTS: Use of hydroxyurea before mobilization may result in unsuccessful stem cell mobilization. Use of antiretrovirals before mobilization and apheresis may interfere with the production of betibeglogene autotemcel. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discontinue antiretrovirals and hydroxyurea for at least one month prior to mobilization and until all cycles of apheresis are completed. If a patient requires antiretrovirals for HIV prophylaxis, then confirm a negative HIV test before beginning mobilization and apheresis of CD34+ cells. DISCUSSION: Antiretroviral medications and hydroxyurea may interfere with the manufacturing of betibeglogene autotemcel therapy.(1) |
ZYNTEGLO |
| Elivaldogene Autotemcel/Anti-Retrovirals SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Elivaldogene autotemcel is prepared from apheresed cells that are transduced with a replication defective, self-inactivating lentiviral vector. Antiretrovirals may interfere with the manufacturing of apheresed cells. CLINICAL EFFECTS: Use of antiretrovirals before mobilization and apheresis may interfere with the production of elivaldogene autotemcel. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discontinue antiretrovirals for at least one month prior to mobilization and until all cycles of apheresis are completed. If a patient requires antiretrovirals for HIV prophylaxis, then confirm a negative HIV test before beginning mobilization and apheresis of CD34+ cells. DISCUSSION: Antiretroviral medications may interfere with the manufacturing of elivaldogene autotemcel therapy.(1) |
SKYSONA |
| Lovotibeglogene Autotemcel/Anti-Retrovirals SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Lovotibeglogene autotemcel is prepared from apheresed cells that are transduced with a replication defective, self-inactivating lentiviral vector. Antiretrovirals may interfere with the manufacturing of apheresed cells. CLINICAL EFFECTS: Use of antiretrovirals before mobilization and apheresis may interfere with the production of lovotibeglogene autotemcel.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discontinue antiretrovirals for at least one month prior to mobilization and until all cycles of apheresis are completed.(1) There are some long-acting antiretroviral medications that may require a longer duration of discontinuation for elimination of the medication. If a patient is taking anti-retrovirals for HIV prophylaxis, confirm a negative test for HIV before beginning mobilization and apheresis of CD34+ cells.(1) DISCUSSION: Antiretroviral medications may interfere with the manufacturing of lovotibeglogene autotemcel therapy.(1) |
LYFGENIA |
| Atidarsagene Autotemcel/Anti-Retrovirals SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Atidarsagene autotemcel is prepared from apheresed cells that are transduced with a replication defective, self-inactivating lentiviral vector. Antiretrovirals may interfere with the manufacturing of apheresed cells. CLINICAL EFFECTS: Use of antiretrovirals before mobilization and apheresis may interfere with the production of atidarsagene autotemcel. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discontinue antiretrovirals for at least one month prior to mobilization (or the expected duration of time needed for elimination of the medication) until all cycles of apheresis are completed. If a patient requires antiretrovirals for HIV prophylaxis, then confirm a negative HIV test before beginning mobilization and apheresis of CD34+ cells. DISCUSSION: Antiretroviral medications may interfere with the manufacturing of atidarsagene autotemcel therapy.(1) |
LENMELDY |
There are 0 moderate interactions.
The following contraindication information is available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
Drug contraindication overview.
*Previous hypersensitivity reaction to cabotegravir. *Coadministration with carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine; significant decreases in cabotegravir plasma concentrations may occur due to uridine diphosphate (UDP)-glucuronosyl transferase (UGT)1A1 enzyme induction, which may result in loss of virologic response. *For HIV-1 pre-exposure prophylaxis: Unknown or positive HIV-1 status.
*Previous hypersensitivity reaction to cabotegravir. *Coadministration with carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine; significant decreases in cabotegravir plasma concentrations may occur due to uridine diphosphate (UDP)-glucuronosyl transferase (UGT)1A1 enzyme induction, which may result in loss of virologic response. *For HIV-1 pre-exposure prophylaxis: Unknown or positive HIV-1 status.
There are 0 contraindications.
There are 0 severe contraindications.
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Disease of liver |
The following adverse reaction information is available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
Adverse reaction overview.
The most common adverse reactions reported in at least 3 HIV-infected patients receiving oral cabotegravir include fatigue, headache, diarrhea, nausea, dizziness, abnormal dreams, anxiety, insomnia, abdominal discomfort, abdominal distension, and asthenia. The most common adverse reactions reported in >=1% of HIV-uninfected patients receiving oral cabotegravir include headache, diarrhea, nausea, dizziness, upper respiratory tract infection, somnolence, fatigue, abnormal dreams, and abdominal pain. The most common adverse reactions reported in >=1% of patients receiving cabotegravir extended-release injection include injection site reactions, diarrhea, headache, pyrexia, fatigue, sleep disorders, nausea, dizziness, flatulence, abdominal pain, vomiting, myalgia, rash, decreased appetite, somnolence, back pain, and upper respiratory infection.
The most common adverse reactions reported in at least 3 HIV-infected patients receiving oral cabotegravir include fatigue, headache, diarrhea, nausea, dizziness, abnormal dreams, anxiety, insomnia, abdominal discomfort, abdominal distension, and asthenia. The most common adverse reactions reported in >=1% of HIV-uninfected patients receiving oral cabotegravir include headache, diarrhea, nausea, dizziness, upper respiratory tract infection, somnolence, fatigue, abnormal dreams, and abdominal pain. The most common adverse reactions reported in >=1% of patients receiving cabotegravir extended-release injection include injection site reactions, diarrhea, headache, pyrexia, fatigue, sleep disorders, nausea, dizziness, flatulence, abdominal pain, vomiting, myalgia, rash, decreased appetite, somnolence, back pain, and upper respiratory infection.
There are 12 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Angioedema DRESS syndrome Hypersensitivity drug reaction Increased alanine transaminase Increased aspartate transaminase Nephrotic syndrome Stevens-johnson syndrome Stomatitis Suicidal Suicidal ideation Toxic epidermal necrolysis |
There are 31 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Back pain Diarrhea Dizziness Dream disorder Drowsy Fatigue Headache disorder Injection site sequelae Insomnia Musculoskeletal pain Nausea Skin rash Sleep disorder Symptoms of anxiety Upper respiratory infection |
Anorexia Fever Flatulence Pruritus of skin Vomiting |
| Rare/Very Rare |
|---|
|
Allergic conjunctivitis Depression Eosinophilia General weakness Hypercholesterolemia Hypertriglyceridemia Mood changes Myalgia Urticaria Weight gain |
The following precautions are available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
Safety, efficacy, and pharmacokinetics of cabotegravir and cabotegravir sodium have not been established in pediatric patients younger than 12 years of age or weighing <35 kg. Safety, efficacy, and pharmacokinetics of oral and injectable cabotegravir were evaluated in 8 HIV-1-infected pediatric patients 12 to <18 years of age weighing >=35 kg in an ongoing, open-label, non-comparative clinical trial (MOCHA; IMPAACT 2017). Safety of cabotegravir observed in pediatric patients in this trial is expected to be similar to that reported in adults receiving the drug.
In addition, drug exposure to cabotegravir was similar to that in adults. Safety and efficacy of oral cabotegravir for HIV-1 PrEP in pediatric patients >=12 years of age weighing >=35 kg who are at risk of HIV-1 infection are supported by data from 2 controlled clinical trials in adults. Safety and efficacy of injectable cabotegravir are being evaluated in 54 pediatric patients 12 to <18 years of age who are at risk of HIV-1 infection in 2 ongoing, open-label, multicenter clinical trials.
Safety of cabotegravir observed in pediatric patients in these trials is similar to that reported in adults receiving the drug. When cabotegravir is used for HIV-1 PrEP in pediatric patients, HIV-1 testing should be conducted prior to initiating therapy and prior to each scheduled injection of cabotegravir extended-release injectable suspension. Adolescents may benefit from more frequent visits and counseling to support adherence to the dosing schedule.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
In addition, drug exposure to cabotegravir was similar to that in adults. Safety and efficacy of oral cabotegravir for HIV-1 PrEP in pediatric patients >=12 years of age weighing >=35 kg who are at risk of HIV-1 infection are supported by data from 2 controlled clinical trials in adults. Safety and efficacy of injectable cabotegravir are being evaluated in 54 pediatric patients 12 to <18 years of age who are at risk of HIV-1 infection in 2 ongoing, open-label, multicenter clinical trials.
Safety of cabotegravir observed in pediatric patients in these trials is similar to that reported in adults receiving the drug. When cabotegravir is used for HIV-1 PrEP in pediatric patients, HIV-1 testing should be conducted prior to initiating therapy and prior to each scheduled injection of cabotegravir extended-release injectable suspension. Adolescents may benefit from more frequent visits and counseling to support adherence to the dosing schedule.
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Antiretroviral Pregnancy Registry at 800-258-4263 or https://www.apregistry.com.
The manufacturer states that data are insufficient regarding use of oral cabotegravir or extended-release cabotegravir injection in pregnant females to inform a drug-associated risk of birth defects or miscarriage. In animal reproduction studies, there was evidence of adverse embryofetal or pre- and post-natal development with oral cabotegravir at systemic exposures approximately 28 times higher (rats) than human exposures at the maximum recommended human dosage. There was no evidence of adverse development with oral cabotegravir given during organogenesis at systemic exposures approximately 28 times higher (rats or rabbits) than or similar to human exposures at the maximum recommended human dosage.
The Health and Human Services Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission states that data are not available regarding use of cabotegravir for the treatment of HIV-1 infection during pregnancy and, therefore, cabotegravir is not recommended as a complete treatment regimen in pregnant females or females of reproductive potential trying to conceive. The Panel recommends that pregnant individuals who present to care on this regimen should be switched to an appropriate three-drug antiretroviral regimen recommended for use in pregnancy.
The manufacturer states that data are insufficient regarding use of oral cabotegravir or extended-release cabotegravir injection in pregnant females to inform a drug-associated risk of birth defects or miscarriage. In animal reproduction studies, there was evidence of adverse embryofetal or pre- and post-natal development with oral cabotegravir at systemic exposures approximately 28 times higher (rats) than human exposures at the maximum recommended human dosage. There was no evidence of adverse development with oral cabotegravir given during organogenesis at systemic exposures approximately 28 times higher (rats or rabbits) than or similar to human exposures at the maximum recommended human dosage.
The Health and Human Services Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission states that data are not available regarding use of cabotegravir for the treatment of HIV-1 infection during pregnancy and, therefore, cabotegravir is not recommended as a complete treatment regimen in pregnant females or females of reproductive potential trying to conceive. The Panel recommends that pregnant individuals who present to care on this regimen should be switched to an appropriate three-drug antiretroviral regimen recommended for use in pregnancy.
It is not known whether cabotegravir is distributed into human milk; however, the drug is distributed into animal milk. When a drug is present in animal milk, it is likely present in human milk. It is not known whether cabotegravir affects human milk production or affects the breast-fed infant.
However, because detectable concentrations of cabotegravir remain in systemic circulation for up to 12 months after discontinuing cabotegravir extended-release injection, it is recommended that women receiving this treatment breastfeed only if the expected benefit justifies the potential risk to the infant. The HHS perinatal HIV transmission guideline provides updated recommendations on infant feeding. The guideline states that patients with HIV should receive evidence-based, patient-centered counseling to support shared decision making about infant feeding.
During counseling, patients should be informed that feeding with appropriate formula or pasteurized donor human milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant. Additionally, achieving and maintaining viral suppression with antiretroviral therapy during pregnancy and postpartum reduces the risk of breastfeeding HIV transmission to <1%, but does not completely eliminate the risk. Replacement feeding with formula or banked pasteurized donor milk is recommended when patients with HIV are not on antiretroviral therapy and/or do not have a suppressed viral load during pregnancy (at a minimum throughout the third trimester), as well as at delivery.
However, because detectable concentrations of cabotegravir remain in systemic circulation for up to 12 months after discontinuing cabotegravir extended-release injection, it is recommended that women receiving this treatment breastfeed only if the expected benefit justifies the potential risk to the infant. The HHS perinatal HIV transmission guideline provides updated recommendations on infant feeding. The guideline states that patients with HIV should receive evidence-based, patient-centered counseling to support shared decision making about infant feeding.
During counseling, patients should be informed that feeding with appropriate formula or pasteurized donor human milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant. Additionally, achieving and maintaining viral suppression with antiretroviral therapy during pregnancy and postpartum reduces the risk of breastfeeding HIV transmission to <1%, but does not completely eliminate the risk. Replacement feeding with formula or banked pasteurized donor milk is recommended when patients with HIV are not on antiretroviral therapy and/or do not have a suppressed viral load during pregnancy (at a minimum throughout the third trimester), as well as at delivery.
Use caution when administering cabotegravir in geriatric patients. Experience in patients >=65 years of age is insufficient to determine whether these patients respond differently to cabotegravir than younger adults. Cabotegravir products should be used with caution in geriatric patients because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.
The following prioritized warning is available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir):
WARNING: Before starting this medication, you must first get tested to be sure you are HIV negative. Your doctor will order lab tests before starting this medication and during treatment to make sure you do not have HIV infection. Using this product will not always prevent HIV infection.
To get the most benefit, use this medication exactly as directed and follow all prevention actions (see also Uses section). Some HIV tests can miss HIV infection in a person who has recently become infected. Tell your doctor right away if you have any signs of HIV infection such as a sore throat that doesn't go away, tiredness, fever, night sweats, rash, diarrhea, joint/muscle aches, enlarged lymph nodes.
If you become HIV positive, you will need to take other medications to treat HIV. If you have HIV and receive only this medication, your HIV may become harder to treat.
WARNING: Before starting this medication, you must first get tested to be sure you are HIV negative. Your doctor will order lab tests before starting this medication and during treatment to make sure you do not have HIV infection. Using this product will not always prevent HIV infection.
To get the most benefit, use this medication exactly as directed and follow all prevention actions (see also Uses section). Some HIV tests can miss HIV infection in a person who has recently become infected. Tell your doctor right away if you have any signs of HIV infection such as a sore throat that doesn't go away, tiredness, fever, night sweats, rash, diarrhea, joint/muscle aches, enlarged lymph nodes.
If you become HIV positive, you will need to take other medications to treat HIV. If you have HIV and receive only this medication, your HIV may become harder to treat.
The following icd codes are available for CABOTEGRAVIR ER (CABENUVA) (cabotegravir)'s list of indications:
| HIV infection | |
| B20 | Human immunodeficiency virus [HIv] disease |
| B97.35 | Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere |
| O98.7 | Human immunodeficiency virus [HIv] disease complicating pregnancy, childbirth and the puerperium |
| O98.71 | Human immunodeficiency virus [HIv] disease complicating pregnancy |
| O98.711 | Human immunodeficiency virus [HIv] disease complicating pregnancy, first trimester |
| O98.712 | Human immunodeficiency virus [HIv] disease complicating pregnancy, second trimester |
| O98.713 | Human immunodeficiency virus [HIv] disease complicating pregnancy, third trimester |
| O98.719 | Human immunodeficiency virus [HIv] disease complicating pregnancy, unspecified trimester |
| O98.72 | Human immunodeficiency virus [HIv] disease complicating childbirth |
| O98.73 | Human immunodeficiency virus [HIv] disease complicating the puerperium |
| Z21 | Asymptomatic human immunodeficiency virus [HIv] infection status |
| HIV infection pre-exposure prophylaxis | |
| Z29.81 | Encounter for HIV pre-exposure prophylaxis |
| Z72.5 | High risk sexual behavior |
| Z72.51 | High risk heterosexual behavior |
| Z72.52 | High risk homosexual behavior |
| Z72.53 | High risk bisexual behavior |
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