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. 2025 Apr 30;80(4):864-870.
doi: 10.1093/cid/ciae500.

Viral Suppression Rates at 48 Weeks in People With HIV Starting Long-Acting Cabotegravir/Rilpivirine With Initial Viremia

Matthew D Hickey  1 , Nathanael Gistand  1 , Janet Grochowski  1 , Francis Mayorga-Munoz  1 , Elizabeth Imbert  1 , John D Szumowski  2 , Jon Oskarsson  1 , Mary Shiels  1 , Samantha Dilworth  1 , Ayesha Appa  1 , Diane V Havlir  1 , Monica Gandhi  1 , Katerina Christopoulos  1
Affiliations

Viral Suppression Rates at 48 Weeks in People With HIV Starting Long-Acting Cabotegravir/Rilpivirine With Initial Viremia

Matthew D Hickey et al. Clin Infect Dis. .

Abstract

Background: We previously demonstrated at the Ward 86 human immunodeficiency virus (HIV) clinic in San Francisco that long-acting (LA) cabotegravir (CAB)/rilpivirine (RPV) (LA-CAB/RPV) can rapidly lead to viral suppression in people with HIV (PWH) with viremia due to adherence challenges. We now evaluate the durability of viral suppression in this population.

Methods: We conducted a retrospective cohort study of PWH who started LA-CAB/RPV with viremia (HIV RNA viral load ≥50 copies/mL) before December 2022. Our primary outcome was viral suppression (viral load <50 copies/mL) with LA-CAB/RPV persistence (not discontinued or late by >14 days) at 48 weeks, using the viral load closest to 48 ± 8 weeks. We also describe viral failure, defined as a <2-log decline in viral load at 4 weeks or a viral load ≥200 copies/mL after initial viral suppression with emergent CAB- or RPV-associated resistance mutations; overall 48-week viral suppression including those switched to alternative antiretroviral therapy (ART).

Results: Fifty-nine PWH initiated LA-CAB/RPV with viremia and were included in the analysis; 49% had a CD4 cell count <200/µL, and the median baseline viral load was 42 900 copies/mL (quarter 1-quarter 3, 5272-139 038). At 48 weeks, 47 PWH met the primary outcome of viral suppression with LA-CAB/RPV persistence (80% [95% confidence interval, 67%-89%]). Five had viral failure with resistance (3 with RPV-associated and 2 with CAB- and RPV-associated mutations), and 1 was lost to follow-up. At week 48, 2 of those with viral failure were suppressed on alternative regimens (lenacapavir + bictegravir/tenofovir alafenamide/emtricitabine and CAB + lenacapavir). The overall viral suppression at week 48 with either LA-CAB/RPV or alternative ART was 92% (54 of 59).

Conclusions: In PWH initiating LA-CAB/RPV with initial viremia, 48-week viral suppression (<50 copies/mL) was seen in 92%. LA ART can be an important tool for improving viral suppression among patients who face adherence challenges to oral ART.

Keywords: HIV/AIDS; injectable cabotegravir and rilpivirine; long-acting antiretroviral therapy; viral suppression; viremia.

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Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/48-week-viral-suppression-rates-in-people-with-hiv-starting-long-acting-cab-rpv-with-initial-viremia-e96411a0-d008-4ac6-bf5d-8e30dcaec8b0
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