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. 2025 Apr;41(4):181-188.
doi: 10.1089/aid.2024.0083. Epub 2025 Feb 3.

Transient Viremia Among People with HIV Receiving Injectable Cabotegravir Plus Rilpivirine

Lauren F O'Connor  1 , Wei Li Adeline Koay  2   3 , Justin Unternaher  2 , Morgan Byrne  1 , Anne K Monroe  1 , Alan Greenberg  1 , Amanda D Castel  1 , Natella Rakhmanina  2   4   5 ; DC Cohort Executive Committee
Affiliations

Transient Viremia Among People with HIV Receiving Injectable Cabotegravir Plus Rilpivirine

Lauren F O'Connor et al. AIDS Res Hum Retroviruses. 2025 Apr.

Abstract

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) provides an effective treatment option for people with HIV (PWH). Studies suggest that PWH on LAI CAB/RPV may experience isolated episodes of transient viremia (HIV RNA > 20 copies/mL) defined as virologic blips (VB). The risk factors for VB in PWH receiving LAI CAB/RPV are limited. We aimed to describe a cohort of PWH on LAI CAB/RPV and evaluate risk factors and time to VB following LAI CAB/RPV initiation. We obtained DC Cohort data from PWH who initiated LAI CAB/RPV prior to July 2023 and used Kaplan-Meier curves and Cox proportional hazards models to evaluate the association between participant demographics, HIV clinical factors, and time to VB. Among 98 PWH who initiated LAI CAB/RPV, 9 (9.2%) experienced at least one VB (median HIV RNA = 50 copies/mL; ranges 30-12,000 copies/mL) during a median follow-up period of five months (IQR: 2-10). The median CD4 count among PWH was 754 cells/µL (IQR: 598, 980) at the time of LAI CAB/RPV initiation. Having a high CD4 (≥ 500 cells/μL) at LAI CAB/RPV initiation was significantly associated with a lower hazard for VB when compared to baseline CD4 < 200 cells/µL [hazard ratios (HR): 0.15 [95% confidence intervals (CI): 0.03, 0.77]; aHR: 0.07 (95% CI: 0.01, 0.50); log-rank p = .026]. No other characteristics were significantly associated with time to VB, and no participants experienced virologic failure. Considerations for baseline CD4 may be important when initiating a patient on LAI CAB/RPV, and future studies will help evaluate the VB occurrence and associated factors among PWH.

Keywords: HIV; cabotegravir-rilpivirine; injectable; long-acting; viremia.

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