P-374. Long-term Effectiveness of Long-Acting Cabotegravir and Rilpivirine in an Infectious Disease Office-Based HIV Program

TL;DR

This study shows that a long-acting HIV treatment program in infectious disease offices maintains viral suppression with high adherence over time.

Contribution

The study evaluates the long-term effectiveness of an office-based LA CAB/RPV program for HIV management.

Findings

94.8% of injections were administered on schedule with high adherence.

91 out of 94 patients remained virologically suppressed after multiple doses.

One-third of discontinuations were due to financial or payor issues.

Abstract

Long-acting cabotegravir and rilpivirine (LA CAB/RPV) was approved in 2021 for treatment of HIV-1 to replace current antiretroviral therapy (ART) in those who are virologically suppressed with a viral load (VL) < 50 copies/mL. Challenges with patient access led to development of a standardized office-based LA CAB/RPV program in a network of Infectious Disease offices in the US. We reported initial success and patient adherence in 2024, and this study evaluates the long-term effectiveness of the LA CAB/RPV program.Table 1.Baseline Demographics and Treatment CharacteristicsFigure 1.Virologic Outcomes at Baseline and Follow-Up

Baseline Demographics and Treatment Characteristics

Virologic Outcomes at Baseline and Follow-Up

The LA CAB/RPV program was initiated in July 2023 and the first 100 patients were followed through April 2025. Data collection included demographics, prior therapy, baseline and follow-up VL, adherence to schedule, adverse events, and reasons for discontinuation. Adherence was defined as LA CAB/RPV received within 7 days of target date.Table 2.Reasons for discontinuation

Reasons for discontinuation

100 pts from 20 sites were included. Patient and treatment characteristics are in Table 1. Median age was 49 years (IQR 39-59) with 81% male. Median BMI was 29.2 kg/m2 (IQR 27.1-31.9), with 38% ≥30 kg/m2. The majority (98%) received 2-month injections. The duration of therapy with LA CAB/RPV was 13 months (median, IQR 11-15), with 753 injections administered to date. Injections were administered on schedule in 94.8% of all doses. Virologic outcomes are noted in Figure 1. The baseline VL was 29 c/mL (median, IQR 20-54) and 94% were virologically suppressed at initiation of LA CAB/RPV. After a median of 8 doses (IQR 7-9) and for those with follow-up VL, 91 remained suppressed with a VL non-detectable (IQR 0-0). One had a VL of 84 copies/mL. Overall, 21 discontinued therapy, with reasons noted in Table 1. One third discontinued due to financial or payor issues. Non-serious adverse events occurred in 6%, with 4 resulting in discontinuation.

An ID physician office based LA CAB/RPV program demonstrated durability in maintenance of virologic suppression with high injection adherence. These results suggest that LA CAB/RPV administered through a standardized ID office-based program is effective in managing HIV-1.

Nikhil K. Bhayani, MD, FIDSA, Cumberland Pharmaceuticals: Advisor/Consultant|Melinta: Advisor/Consultant|Paratek Pharmaceuticals: Advisor/Consultant Brian S. Metzger, MD, MPH, Abbvie: Advisor/Consultant|Cumberland Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant Richard L. Hengel, MD, FIDSA, Gilead: Grant/Research Support Lucinda J. Van Anglen, PharmD, FIDSA, Cumberland Pharmaceuticals: Grant/Research Support|Ferring Pharmaceuticals: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Novartis: Grant/Research Support|Takeda Pharmaceuticals: Grant/Research Support

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