Demonstration Project of Long-Acting Antiretroviral Therapy in a Diverse Population of People With HIV

Background: Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) reg -imen approved for people with HIV (PWH). Long-acting ART holds promise for improving outcomes among populations with barriers to adherence but is only approved for PWH who have virologic suppression with use of oral ART before initiat-ing injectables.Objective: To examine LA-ART in a population of PWH that includes those with viremia.Design: Observational cohort study. Setting: Urban academic safety-net HIV clinic.Patients: Publicly insured adults living with HIV with and with-out viral suppression, high rates of unstable housing, mental illness, and substance use.Intervention: Demonstration project of long-acting injectable CAB-RPV.Measurements: Descriptive statistics summarizing cohort outcomes to date, based on pharmacy team logs and electronic medical record data.Results: Between June 2021 and November 2022, 133 PWH at the Ward 86 HIV Clinic were started on LA-ART, 76 of whom had virologic suppression while using oral ART and 57 of whom had viremia. The median age was 46 years (IQR, 25 to 68 years); 117 (88%) were cisgender men, 83 (62%) had non-White race, 56 (42%) were experiencing unstable housing or homelessness, and 45 (34%) had substance use. Among those with virologic suppression, 100% (95% CI, 94% to 100%) maintained suppression. Among PWH with viremia, at a median of 33 days, 54 of 57 had viral suppression, 1 showed the expected 2-log10 reduction in HIV RNA level, and 2 experienced early virologic failure. Overall, 97.5% (CI, 89.1% to 99.8%) were projected to achieve virologic suppression by a median of 33 weeks. The current virologic failure rate of 1.5% in the cohort is similar to that across registrational clinical trials at 48 weeks.Limitation: Single-site study.Conclusion: This project demonstrates the ability of LA-ART to achieve virologic suppression among PWH, including those with viremia and challenges to adherence. Further data on the ability of LA-ART to achieve viral suppression in people with barriers to adherence are needed.Primary Funding Source: National Institutes of Health, City and County of San Francisco, and Health Resources and Services Administration. Ann Intern Med. doi:10.7326/M23-0788 Annals.org For author, article, and disclosure information, see end of text. This article was published at Annals.org on 4 July 2023.