Background
Real world data continues to accumulate regarding the efficacy of long acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV); however, limited data exists regarding virologic outcomes in those returning to oral therapy after discontinuing LAI CAB/RPV.
Methods
Single-center cohort study at the UC San Diego Owen Clinic in those who initiated LAI CAB/RPV but discontinued treatment between 4/2021 and 3/2024. Included were those that received at least 1 injection, with discontinuation prior to 3/2024 to allow for at least 24 weeks of follow up. Excluded were those on LAI CAB/RPV who transferred care out of the clinic as it was often unknown if LAI CAB/RPV was continued. Baseline characteristics and reasons for discontinuation, pre- and post-switch oral antiretroviral (ART) regimens, and virologic outcomes after discontinuation of LAI CAB/RPV were collected. Viral load (VL) time points after discontinuation included the most recent in the range of 1-24 weeks, 24-48 weeks, and the most recent documented viral load through 9/2024.
Results
A total of 92 patients were included who discontinued LAI CAB/RPV during the study period. The median age (IQR) was 38 (34-50), 52.2% were non-White race, 37% were Hispanic, 20.7% were female sex assigned at birth, and 33% had active substance use. The majority (78.2%) were on an integrase inhibitor (INSTI) based regimen pre-switch and 90.2% had an HIV VL<50 copies/mL (cpm) prior to starting LAI CAB/RPV with a median CD4 count of 706 cells/mm3. The median (IQR) number of CAB/RPV injections received before discontinuation was 4 (2-6) and the median (IQR) time on LAI CAB/RPV was 164 (59-305) days. Table 1 includes the reasons for discontinuing LAI CAB/RPV. The majority of patients (76.6%) switched to an INSTI based regimen after stopping LAI CAB/RPV, with 75.3% returning to the same pre-switch regimen, and 80.4% had a last VL<50cpm at the time of stopping LAI CAB/RPV (9 patients had no VL data on LAI CAB/RPV). A total of 58 patients had VL data available at 24 weeks, 53 at 48 weeks, and 74 with at least one VL after discontinuation (median time to last VL 342 days). The percentage of those with HIV VL <50cpm and <200cpm up to 24 weeks was 91.4% and 94.8%, up to 48 weeks was 90.6% and 96.2%, and using the most recent documented VL was 91.9% and 95.9%, respectively.
Conclusions
In those who discontinued LAI CAB/RPV, returned to oral ART, and remained engaged in care, a high rate of ongoing viral suppression was observed.
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