Could Long-Acting Cabotegravir-Rilpivirine Be the Future for All People Living with HIV? Response Based on Genotype Resistance Test from a Multicenter Italian Cohort

Abstract

Long-acting (LA) formulations have been designed to improve the quality of life of people with HIV (PWH) by maintaining virologic suppression. However, clinical trials have shown that patient selection is crucial. In fact, the HIV-1 resistance genotype test and the Body Mass Index of individual patients assume a predominant role in guiding the choice. Our work aimed to estimate the patients eligible for the new LA therapy with cabotegravir (CAB) + rilpivirine (RPV). We selected, from the Antiviral Response Cohort Analysis (ARCA) database, all PWH who had at least one follow-up in the last 24 months. We excluded patients with HBsAg positivity, evidence of non-nucleoside reverse transcriptase inhibitor (except K103N) and integrase inhibitor mutations, and with a detectable HIV-RNA (>50 copies/mL). Overall, 4103 patients are currently on follow-up in the ARCA, but the eligible patients totaled 1641 (39.9%). Among them, 1163 (70.9%) were males and 1399 were Caucasian (85.3%), of which 1291 (92%) were Italian born. The median length of HIV infection was 10.2 years (IQR 6.3–16.3) with a median nadir of CD4 cells/count of 238 (106–366) cells/mm3 and a median last available CD4 cells/count of 706 (509–944) cells/mm3. The majority of PWH were treated with a three-drug regimen (n = 1116, 68%). Among the 525 (30.3%) patients treated with two-drug regimens, 325 (18.1%) were treated with lamivudine (3TC) and dolutegravir (DTG) and only 84 (5.1%) with RPV and DTG. In conclusion, according to our snapshot, roughly 39.9% of virologically suppressed patients may be suitable candidates for long-acting CAB+RPV therapy. Therefore, based on our findings, many different variables should be taken into consideration to tailor the antiretroviral treatment according to different individual characteristics.

Are we ready for long‐acting? A feasibility evaluation of long‐acting cabotegravir–rilpivirine in clinical practice

“…Finally, this study reflects the reality at our center and more data could be available in multicentric analyses. Note that another multicentric study seems to confirm our data, with a percentage of almost 60% of the entire population (also considering women of childbearing potential) not considered eligible for LA therapy 15 …”

“…The rate of resistance to INIs was even less (0.2%).Also, the number of individuals who were administered the preference questionnaire was only 10.3% of the studied population and, therefore, cannot be considered representative of the entire sample.Finally, this study reflects the reality at our center and more data could be available in multicentric analyses. Note that anotherF I G U R E 1 Clinical exclusion criteria for cabotegravir-rilpivirine BORGHETTI ET AL.| 4973 multicentric study seems to confirm our data, with a percentage of almost 60% of the entire population (also considering women of childbearing potential) not considered eligible for LA therapy 15. Despite its limitations, our study also has important strengths that allow for insights into the simplification of the long-acting strategy.…”

Injectable Long-Acting Cabotegravir–Rilpivirine Therapy for People Living With HIV/AIDS: Addressing Implementation Barriers From the Start

“…COVID-19 disruptions included the closure of community sites and the rise of telemedicine, which made it impossible for some patients to receive CAB/RPV injections. As we face uncertain times and possible future pandemics, stakeholders are encouraged to implement home delivery of long-acting drugs, increase staff to manage and reschedule missed appointments, and acquire equipment to appropriately refrigerate CAB/RPV between 2°C and 8°C (De Vito et al, 2022). Research shows that early linkage to HIV health care improves the odds of viral suppression, a major goal of the care continuum.…”

Immune Responses to HBV Vaccine in People Living with HIV (PLWHs) Who Achieved Successful Treatment: A Prospective Cohort Study

“…Some patients treated with a TDF or TAF-based regimens are protected from HBV infection [ 5 ]. However, the new long-acting drugs such as cabotegravir and rilpivirine cannot protect from HBV, and people with HBV are not eligible for this treatment [ 6 ]. Therefore, vaccination is strongly suggested for a better treatment choice and, consequently, a better quality of life in PLWHs with negative hepatitis B serology [ 7 ].…”