Background
The association of intramuscularly administered Long-acting cabotegravir and rilpivirine (LA CAB+RPV) has been proven to be effective and safe in the maintenance treatment of people with HIV (PWH). The study aimed to assess LA CAB+RPV efficacy and safety in Older PWH (OPWH).
Methods
PWH in the GEPPO cohort (age >65 years) who started LA CAB+RPV were included. Duration of LA CAB+RPV administration, reasons for drug preference and discontinuation, and HIV RNA/CD4 cell count at the last available observation were recorded together with geriatric variables, including multimorbidity (defined as the presence of ≥3 comorbidities) and polypharmacy (defined as the use of ≥5 medications other than antiretroviral therapy). Baseline (BL) was defined as the time when participants started LA CAB+RPV.
Results
Seventy-eight PWH were included. They were mostly male (75.9%) and aged 66.7 years (65-70) at BL. A long time since HIV diagnosis [20 (14-28.5) years] and of ART [19 (13-22) years] as well as moderately low nadir CD4+ T cells [270 (105-410) cell/mm3] were observed. Only three participants had an HIV RNA >50 copies/mL (55, 234, and 945 copies/mL) at the time of the switch. The pre-switch regimen was mainly based on a three-drug combination in 53.5% of study participants (mostly bictegravir or rilpivirine-based) or two-drug combinations by 45.1% (mostly dolutegravir/rilpivirine and dolutegravir/lamivudine). Multimorbidity (61.9%) and polypharmacy (31.9%) were prevalent. A history of NNRTI resistance-associated mutations, an A1/A6 genotype, and a body mass index >30 Kg/m2 were observed in 2 (2.7%), 6 (19.3%), and 10 (14.3%) participants, respectively.
After a median follow-up of 17.4 months (14.1-18.9), 72 participants (92.3%) were still receiving LA CAB+RPV. No virological failure was observed, and HIV RNA remained <50 copies/mL in all PWH; CD4 cell count at the last available observation was 656 (519-964) cells/mm3. The reasons for discontinuation were adverse events (2 subjects: 1 fever/muscular pain and 1 palpitations/paresthesias), patient’s choice (1), death (1), HBV flare in occult B hepatitis (1), and physician’s choice (1).
Conclusions
Our results suggest that the LA CAB+RPV combination is effective and safe in OPWH despite a long history of ART and a high prevalence of multimorbidity and polypharmacy. Older age should not be a barrier to the LA regimen: this study paves the way to evaluate the risk of an ageism attitude when clinicians consider ART choices in older PWH.
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