A newly published real-world study out of the U.S. South offers our latest batch of evidence that long-acting antiretroviral therapy (LA-ART) can be highly effective in people with HIV who have pre-existing viremia. This latest research even suggests significant value of these regimens for people with advanced HIV.
Highlighted Study Population and Methods
Researchers from the Ponce De Leon Center, a Ryan White-funded clinic in Atlanta, conducted a retrospective chart review of people living with HIV who have viremia and initiated LA‑ART. Most patients started a regimen of cabotegravir/rilpivirine (CAB/RPV), but some received lenacapavir (LEN) or even ibalizumab (IBA).
Individuals were included in the analysis if they had viremia (defined as a viral load ≥50 copies/mL) at the time of LA‑ART initiation and received at least three CAB/RPV injections by the end of the follow-up period (which stretched from April 2021 to December2024).
Among 81 initial participants who met these criteria, 93% identified as Black; 40% were cis‑ or transgender women. The median age was 38 years (IWR 30-49) and the median annual income was $25,000 USD (IQR: $20,000-$33,000). Median time since HIV diagnosis was 15.5 years, and 46% had a history of prior opportunistic infection.
At initiation of LA-ART, 56 people received CAB/RPV alone; 22 received CAB/RPV + LEN; and four received other regimens (CAB + LEN; CAB + IBA; or all four drugs). Median baseline viral load was 10,000 copies/mL; median baseline CD4 count was 186 cells/uL.
The primary study outcome was viral suppression (HIV RNA<50 copies/mL) among the 79 patients who remained engaged in treatment through the follow-up period.
Key Findings
Out of 645 LA‑CAB/RPV injections (500 monthly, 145 bi‑monthly), 98% were administered on time. All LEN (43/43) and IBA (37/37) injections were on schedule.
73/79 (92%) achieved viral suppression after a median of a single LA-ART dose (IQR 1-2).
Median CD4 count increase was to 353 cells/uL (IQR: 187-501).
Two individuals experienced virologic failure with emergent drug resistance.
Four people had persistent viremia without resistance (two with >200c/mL; two with 50–200c/mL).
Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.
Source : TheBodyPro
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