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Multicenter Study
. 2025 Aug 1;81(1):67-74.
doi: 10.1093/cid/ciae579.

Real World Virologic Outcomes in Patients With Elevated Body Mass Index Receiving Long Acting Cabotegravir/Rilpivirine

Christina Maguire  1 , Kaitlyn Rueve  2 , Eric Farmer  2 , Emily Huesgen  2 , Antoneta Karaj  3 , Amanda Binkley  1 , Karam Mounzer  4 , Marisa Brizzi  5 , Pallavi Chary  6 , Peter Sung  6 , Amy Graziani  6 , Emily Hiserodt  4 , Jillian Baron  7 , Helen Koenig  7 , William R Short  7
Affiliations
Multicenter Study

Real World Virologic Outcomes in Patients With Elevated Body Mass Index Receiving Long Acting Cabotegravir/Rilpivirine

Christina Maguire et al. Clin Infect Dis. .

Abstract

Background: The first long-acting injectable antiretroviral, cabotegravir/rilpivirine (LA-CAB/RPV), was approved by the Food and Drug Administration (FDA) in January 2021 for persons with human immunodeficiency virus (HIV) suppressed on their current regimen. Body mass index (BMI) ≥30 kg/m2 has been identified as a risk factor for virologic failure; however, data are limited due to small sample sizes. The aim of this study was to evaluate the impact of BMI on the efficacy of LA-CAB/RPV in a real-world setting.

Methods: A retrospective, multicenter cohort study was conducted from 22 January 2021 to 15 February 2023 in individuals who received LA-CAB/RPV every 4 (Q4w) or 8 weeks (Q8w). Individuals included were virologically suppressed on their current regimen, received at least 1 dose of LA-CAB/RPV, and had a follow-up viral load post initiation.

Results: A total of 374 individuals across 5 centers were included, with a BMI ≥30 kg/m2 in 148 (39.5%) individuals. Most individuals received a Q8w (68%) regimen, and the incidence of viral load ≥50 copies/mL was similar between those with BMI ≥30 kg/m2 (12%) as compared to those with BMI <30 kg/m2 (9%) (incidence rate ratio [IRR] 1.31; 95% confidence interval [CI]: .69-2.46, P = .4). Confirmed virologic failure occurred in 0.8% of individuals overall, with 2 of the 3 cases occurring in those with BMI ≥30 kg/m2.

Conclusions: The data from this real-world cohort demonstrates no difference in virologic outcomes for individuals with BMI ≥30 kg/m2 as compared to those with BMI <30 kg/m2 suggesting that higher BMI alone should not preclude use of LA-CAB/RPV in eligible individuals.

Keywords: HIV; antiretrovirals; cabotegravir/rilpivirine; injectable; long-acting; obesity.

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Conflict of interest statement

Potential conflicts of interest . C. M. and A. B. have served as advisory board consultants for Viiv. E. F., E. H., and M. B. serve on the Viiv Speakers Bureau. K. M. has received research grant funding from Viiv paid institutionally and serves on the Viiv Speakers Bureau. W. S. is a consultant for Viiv and receives research grant funding from Viiv paid institutionally. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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