Background:
Long-acting injectable (LAI) cabotegravir (CAB) and rilpivirine (RPV) represent a new treatment option for people with HIV (PWH). We sought to understand early reach and effectiveness outcomes in an academic Ryan White clinic serving a primarily Black/African American patient population.
Methods:
We conducted a retrospective cohort analysis of all PWH referred for LAI CAB/RPV at the University of Chicago HIV clinic from January 1, 2021 to May 31, 2023. We described the socio-demographic and clinical characteristics of the referred PWH. We compared the initiation rate categorized by viral suppression (VS), defined as a viral load <50 copies/mL, using a Fisher's exact test and described early clinical outcomes. Per guidelines, PWH without VS initiated LAI CAB/RPV after VS on oral antiretrovirals.
Results:
Of the 829 PWH in the program, 119 (14%) were referred for LAI CAB/RPV with median age 34, 65% cisgender male, 30% cisgender female, 5% transgender or non-binary, 85% Black, 56% sexual minority men, 32% with psychiatric illness, 8% with substance use, and 61% Medicaid insured. Half of referred PWH had comorbidities, 69% took other pills daily, and 37% had a BMI >30kg/m². At referral, the median time living with HIV was 7 years, 78% received an integrase inhibitor (INSTI)-based regimen, and 12/119 (12%) did not have VS. After a median period of 1 month (IQR 0-3), 78 PWH (66%) started LAI CAB/RPV, of whom 57% had no prior HIV drug resistance test available, 24% received an oral lead-in, and 77% initiated with a bimonthly dosing schedule. The reasons for non-initiation are detailed in Figure 1. PWH without VS at referral were less likely to start treatment (P<0.001). After a median of 5 injections (IQR 3 to 7) and a median follow-up time of 8 months (IQR 5-12 months), all maintained VS except for one virologic failure, with 11/78 (14%) discontinuing LAI CAB/RPV after a median time of 4 months (IQR 1-6 months). Missing visits and adverse events explained two-thirds of discontinuations (Figure 1).
Conclusions:
We found significant referrals for and uptake of LAI CAB/RPV in a clinic serving primarily Black/African American PWH. However, challenges exist in starting PWH on LAI CAB/RPV, especially among those without VS. More work is needed to support providers, patients, and clinic systems to deliver LAI-CAB/RPV to this group.
