Real-world study finds high satisfaction with injectable long-acting cabotegravir/rilpivirine in urban clinic

Most individuals receiving long-acting injectable cabotegravir/rilpivirine in a Chicago clinic expressed high satisfaction with their HIV treatment and planned to continue it, even though injection-site pain was a nearly universal side effect. Almost every patient received their injections within the permissible seven-day window for the next injection.

About This Study

“Acceptability of Long-Acting Cabotegravir + Rilpivirine in a Large, Urban, Ambulatory HIV Clinic” was published online on Aug. 5, 2024, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Casey Morgan Luc, M.P.H., of the University of Illinois Chicago School of Public Health in Chicago. Some of the data were previously presented at the 2024 Conference on Retroviruses and Opportunistic Infections in Denver, Colorado.

Key Research Findings

Researchers surveyed 150 people at a single HIV clinic who were prescribed long-acting injectable cabotegravir and rilpivirine, asking about their views on this treatment modality. Many participants were heterosexual Black men (67% of participants Black, 56% of participants cisgender men, 55% of participants heterosexual), with 37% of participants ≥50 years old.

The opportunity to stop taking daily pills was the most common reason for switching to injectable treatment. Changing injection appointments was common, but only seven participants received their injection more than a week late. Satisfaction was high (6.7/7) and didn’t differ significantly by the experience or severity of injection-site reactions, with 91% of participants saying they were very likely to continue the treatment.

While 98% of participants reported experiencing pain from their most recent injection (with an average “level of bother” of 4.3 on a 10-point scale), 47% of those said that this side effect improved after their first injection. However, 78% of the 36 participants who reported severe pain (score >6/10), said it didn’t improve during subsequent injections. Injection site swelling and hardening were other common side effects, reported by 20% and 22% of participants, respectively.

Participants noted that they were feeling better physically and/or psychologically, treatment was more convenient, and travel easier after switching from daily oral treatment. Ten percent of participants reported negative effects, including mood swings and challenges in getting insurance coverage.

Discussion Highlights and Implications for Practice

Study limitations reported by the researchers included a lack of information on whether injections were stopped later, potential recall bias when rating pain severity, and study participants’ demographic characteristics that limit the transferability of results to other population.

The researchers believe that the high satisfaction reported despite injections-site pain may indicate that participants decided the benefits of long-acting treatment outweighed the discomfort. When cabotegravir (which is also available orally) is considered for a patient, the provider should discuss the injectable option with their patient, study authors recommended.

By Barbara Jungwirth