Long-acting cabotegravir and rilpivirine combination shows sustained HIV control in seniors

The long-acting injectable combination of cabotegravir and rilpivirine (CAB plus RPV) demonstrated high virologic suppression and a low rate of virologic failure in people with HIV infection aged 60 years or older, despite a higher comorbidity burden. Participants in this age group showed better treatment adherence but had slightly higher rates of systemic adverse events.

METHODOLOGY:

• Researchers conducted a sub-analysis of the RELATIVITY cohort to evaluate the real-world effectiveness and safety of the long-acting injectable CAB plus RPV across 58 healthcare institutions in Spain.
• They included 3146 people with HIV infection with virologic suppression (HIV-1 RNA < 50 copies per mL) when they switched to the long-acting injectable CAB plus RPV.
• Overall, 370 participants aged 60 years or older (median age, 63 years; 78.6% male at birth) were compared with 2775 participants younger than 60 years (median age, 43 years; 86.1% male at birth).
• The primary outcome was the maintenance of virologic suppression and the occurrence of virologic failure, which was defined as two consecutive HIV-1 RNA values ≥ 200 copies per mL or a single value > 500 copies per mL leading to treatment discontinuation.
• Secondary outcomes included clinical characteristics, treatment discontinuation, immunologic parameters, safety profiles, and adherence to the injection schedule.

TAKEAWAY:

• The rates of HIV virologic suppression remained high and comparable between the groups at 15 months — 97.3% among participants aged 60 years or older and 96.8% among those younger than 60 years (P = .237). Likewise, the rates of virologic failure were 0.3% and 0.7%, respectively, with no significant difference.
• Permanent treatment discontinuation occurred more frequently in people with HIV infection aged 60 years or older (7.8%) than in those younger than 60 years (6.1%); however, the difference was not statistically significant (P = .211).
• Participants aged 60 years or older had significantly lower median baseline CD4+ counts (P < .001) and CD8+ counts (P = .031) than those younger than 60 years and had stable immunologic parameters throughout the study period.
• Treatment adherence was significantly higher in participants with HIV infection aged 60 years or older than in those younger than 60 years (89.3% vs 83.7%; P = .005). Systemic adverse events were more common in the older group (1.6% vs 0.8%; P = .143).

IN PRACTICE:

“The RELATIVITY study provides compelling real-world evidence that LAI [long-acting injectable] CAB + RPV is an effective and generally well-tolerated option for older people with HIV, even in the context of multimorbidity, polypharmacy, and long ART [antiretroviral therapy] histories,” the authors of the study wrote.

SOURCE:

The study was led by Jesús Troya, Hospital Universitario Infanta Leonor, Madrid, Spain. It was published online on October 21, 2025, in HIV Medicine.

LIMITATIONS:

The ambispective design introduced potential recall and information bias, although the use of standardized electronic records mitigated this risk. Reclassification of discontinuation events according to study definitions may have introduced some subjectivity but still ensured harmonization with international standards. The short follow-up period of less than 18 months for most participants limited conclusions about long-term durability and patient-centered outcomes.

DISCLOSURES:

No funding source was reported for this study. Two authors reported receiving lecture fees from ViiV Healthcare, Janssen Pharmaceuticals, and/or Gilead Sciences, unrelated to the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Edited by Shreyasi Asthana