575. PREFER-LA: Improved Adherence and Viral Control in Real-World Study of People with HIV (PWH) in the United States with Adherence Challenges on Oral Antiretroviral Therapy (ART) Switching to Cabotegravir + Rilpivirine Long-Acting (CAB+RPV LA)

TL;DR

A real-world study shows that switching to CAB+RPV LA improves adherence and viral control in HIV patients with prior adherence issues.

Contribution

The study provides real-world evidence of CAB+RPV LA's effectiveness in people with HIV who had adherence challenges with oral ART.

Findings

Over 98% of participants maintained a viral load under 200 copies/mL after one year on CAB+RPV LA.

Forgetfulness was the most common adherence issue with oral ART, but missed injections of CAB+RPV LA were uncommon.

Most participants had switched from a single tablet oral ART regimen, with over 90% coming from such regimens.

Abstract

Cabotegravir + rilpivirine long acting (CAB +RPV LA) has demonstrated superior efficacy when compared to oral therapy in a randomized controlled trial of people with HIV (PWH) with adherence challenges (LATITUDE). Real-world adherence and clinical outcomes from PREFER-LA (Perspectives on Treatment with CAB+RPV LA Injectable Therapy from PWH in the US with Prior Adherence Challenges to Oral ART) are presented.Table 1.PWH characteristics and demographics (eCRF, n=159)Figure 1.HCP reported type adherence challenge PWH experienced when receiving their previous oral ART (eCRF, n = 159)

PWH characteristics and demographics (eCRF, n=159)

HCP reported type adherence challenge PWH experienced when receiving their previous oral ART (eCRF, n = 159)

PREFER-LA was an observational real-world US study of PWH receiving CAB+RPV LA for ≥6 months to ≤18 months with documented adherence challenges on prior oral ART. The study consisted of: (1) cross-sectional survey of PWH to evaluate experiences of historical oral ART use and perspectives of treatment with CAB+RPV LA, (2) corresponding retrospective medical chart review (eCRF) to establish treatment history and clinical outcomes, and (3) cross-sectional survey of healthcare providers (HCP) from each site.Figure 2.PWH prior ART history (eCRF)Figure 3.Viral suppression status before and after switch to CAB+RPV LA (eCRF, n = 159)

PWH prior ART history (eCRF)

Viral suppression status before and after switch to CAB+RPV LA (eCRF, n = 159)

Median age of the 159 participants was 39 years and median time since HIV diagnosis was 11.7 years (Table 1). HCPs identified the type of sub-optimal adherence for each PWH for study eligibility (Figure 1). HCPs reported forgetfulness (64%) as the most common factor impacting daily oral ART adherence. From the PWH perspective, remembering to take oral ART was the most common adherence challenge (84%). For nearly 70% of PWH, CAB+RPV LA was at least their third ART regimen (Figure 2). Over 90% of PWH switched from a single tablet oral ART; bictegravir/tenofovir alafenamide/emtricitabine (59%) was the most common prior single tablet oral ART. No resistance data were available at time of switch for 38% of PWH. Nearly one quarter of PWH had a viral load >50 copies/mL at time of switch (Figure 3). At the time of evaluation, median follow-up time on CAB+RPV LA was 1 year, and viral load < 200 copies/mL was achieved/maintained in over 98% of PWH (Figure 3). Missed/skipped/delayed CAB+RPV LA injections were uncommon (13%).

In this cohort of PWH with documented adherence challenges to oral ART, virological control was achieved/maintained by most after switching to CAB+RPV LA. These real-world findings complement existing clinical trial and real-world evidence regarding use of CAB+RPV LA in PWH with identified adherence challenges on prior oral ART.

All Authors: No reported disclosures

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