Long-acting injectables work well for people without viral suppression

Long-acting treatment with injectable cabotegravir and rilpivirine (Cabenuva) may be an option for people who are unable to maintain an undetectable viral load on oral antiretroviral treatment, especially if they received enhanced support, according to several studies presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2025) last week in San Francisco.

All modern antiretroviral therapy (ART) is effective and generally well tolerated, so treatment success often depends on consistent use. Some people have difficulty maintaining good adherence because they forget to take their pills, don’t want to think about HIV every day, are concerned about having pill bottles that could reveal their HIV status or are in living situations where their meds could be lost or stolen. For some of these individuals, long-acting treatment may be a better option.

Cabenuva, the first complete regimen that doesn’t require daily pills, is administered by injection once monthly or every other month. The Food and Drug Administration (FDA) approved Cabenuva in 2021 for people with viral suppression on a stable antiretroviral regimen, no history of treatment failure and no resistance to either drug. The Phase III ATLAS trial showed that Cabenuva works as well as daily pills for treatment-experienced people switching from a standard oral regimen with an undetectable viral load. The FLAIR trial found that it also works well for those new to treatment who achieved viral suppression on a temporary oral regimen before switching to injections.

Although people without viral suppression were not included in the pivotal trials that led to Cabenuva’s approval, a growing body of real-world evidence shows that it can be a feasible option for this population as well.

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