High rates of sustained viral suppression seen among people who start injectable HIV treatment with baseline viremia

A California study shows that with intensive support services, people living with HIV who are viremic and have adherence challenges can sustain viral suppression on long-acting injectable HIV treatment.

About This Study

“48-week viral suppression rates in people with HIV starting long-acting CAB/RPV with initial viremia” was published online on Oct. 5, 2024, in Clinical Infectious Diseases. The lead author is Matthew D. Hickey, M.D., of the Division of HIV, Infectious Disease, & Global Medicine at the University of California, in San Francisco.

Key Research Findings

In this retrospective cohort study from 2022 to 2024, researchers investigated viral load development after starting long-acting cabotegravir/rilpivirine while viremic in 59 people living with HIV who attended a single clinic (Ward 86) in San Francisco, California. Most participants were white men over the age of 29 (41% of participants white, 90% of participants men, 49% of participants 30-49 years old, and 48% of participants ≥50 years old). At baseline, 53% of participants were unstably housed or homeless and 63% of participants were using stimulants.

HIV parameters were poor on study drug initiation: 49% of participants had a CD4 cell count <200 copies/mL and 69% of participants had a viral load ≥10,000 copies/mL. Forty-eight weeks later, 47 participants on the study drug and five participants on oral antiretroviral treatment had a viral load <50 copies/mL, for a 92% overall viral suppression rate. Reasons for returning to oral treatment included side effects, needles too short for a body mass index ≥30 kg/m², and moving to a clinic where the study drug was not available.

Some injections were given off-site, such as in an emergency department. Five participants developed viral resistance, all to rilpivirine as well as two to cabotegravir. Three participants discontinued HIV treatment due to mental health challenges and one of them died from complications of AIDS.

Discussion Highlights and Implications for Practice

Study limitations included the small sample size, single site, and provision of additional support services that may not be available in all settings, such as drop-in injections, reminders, and follow-ups, and integrated substance use and mental health treatments.

Results show that long-acting treatment can achieve lasting HIV suppression, at least for 48 weeks, in people with viremia and adherence challenges, especially when intensive support is provided.

By Barbara Jungwirth