<i>Letter to the Editor:</i> Real-Life Experience of Long-Acting Cabotegravir–Rilpivirine Combination in a Person Living with HIV with Detectable Viremia: A Case Report

Ciccullo, Arturo; Iannone, Valentina; Lombardi, Francesca; Borghetti, Alberto; Di Giambenedetto, Simona

doi:10.1089/aid.2023.0057

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Current guidelines advise against use of LA-CAB/RPV for patients who are not virally suppressed because of lack of clinical trial data in this population. 10 Though early data including from Ward 86 and University of Mississippi suggest rapid viral suppression can be achieved in more than 95% of patients starting LA-CAB/RPV when unsuppressed, [11][12][13][14][15] important questions about durability of viral suppression remain, largely because of concerns that adherence to injection appointments may be lower in this population. However, for many patients unable to adhere to oral ART, LA-CAB/RPV may be the only currently available option to prevent HIV progression, opportunistic infections, and death, therefore tipping the risk-benefit balance in favor of starting LA-CAB/RPV.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, early data from clinical cohorts suggest that HIV viral suppression can be obtained in most patients initiating LA-CAB/RPV with an unsuppressed viral load. [11][12][13][14][15] For such patients, LA-CAB/RPV may be the only option to avoid disease progression and onward transmission. Given emerging data on the biological efficacy of LA-CAB/RPV in persons who are not virally suppressed, the question is no longer whether LA-CAB/RPV should be made available for this population but rather how this innovation should be implemented to ensure that treatment is effective, safe, and equitable.…”

Section: Introductionmentioning

confidence: 99%

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Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People with HIV Who Are Virally Unsuppressed

Hickey,

Grochowski,

Mayorga-Munoz

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. Setting: Ward 86, a clinic serving publicly insured PWH in San Francisco Methods: We describe multi-level determinants of and strategies for LA-CAB/RPV implementation for PWH without VS, using the Consolidated Framework for Implementation Research. To assess patient and provider-level determinants, we drew on pre-implementation qualitative data. To assess inner and outer context determinants, we undertook a structured mapping process. Results: Key patient-level determinants included perceived ability to adhere to injections despite oral adherence difficulties and care engagement challenges posed by unmet subsistence needs; strategies to address these determinants included a direct-to-inject approach, small financial incentives, and designated drop-in days. Provider-level determinants included lack of time to obtain LA-CAB/RPV, assess injection response, and follow-up late injections; strategies included centralizing eligibility review with the clinic pharmacist, a pharmacy technician to handle procurement and monitoring, regular multidisciplinary review of patients, and development of a clinic protocol. Ward 86 did not experience many outer context barriers due to rapid and unconstrained inclusion of LA-CAB/RPV on local formularies and ability of its affiliated hospital pharmacy to stock the medication. Conclusion: Multi-level strategies to support LA-CAB/RPV implementation for PWH without VS are required, which may necessitate additional resources in some settings to implement safely and effectively. Advocacy to eliminate outer-context barriers, including prior authorizations and specialty pharmacy restrictions, is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People with HIV Who Are Virally Unsuppressed

Hickey,

Grochowski,

Mayorga-Munoz

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Viral Suppression Rates at 48 Weeks in People With Human Immunodeficiency Virus Starting Long-Acting Cabotegravir/Rilpivirine With Initial Viremia

Hickey,

Gistand,

Grochowski

et al. 2024

Clinical Infectious Diseases

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Background We previously demonstrated at the Ward 86 HIV clinic in San Francisco that long-acting cabotegravir/rilpivirine (LA-CAB/RPV) can rapidly lead to viral suppression (VS) in people with HIV (PWH) with viremia due to adherence challenges. We now evaluate VS durability in this population. Methods We conducted a retrospective cohort study of PWH who started LA-CAB/RPV with viremia (HIV RNA viral load [VL]≥50 copies/mL) before December 2022. Our primary outcome was VS (VL<50 copies/mL) with LA-CAB/RPV persistence (not discontinued or late by >14 days) at 48 weeks, using the closest VL to 48+/-8 weeks. We also describe viral failure (VF), defined as <2-log VL decline at 4 weeks or VL≥200 copies/mL after initial VS with emergent CAB- or RPV-associated resistance mutations; and overall 48-week VS including those switched to alternative ART. Results Fifty nine PWH initiated LA-CAB/RPV with viremia and were included in analysis; 49% had CD4<200 cells/µL and median baseline VL was 42,900 copies/mL (Q1-Q3 5,272-139,038). At 48 weeks, 47 met the primary outcome of VS with LA-CAB/RPV persistence (80%; 95%CI 67-89%). Five had VF with resistance (three with RPV-associated mutations, two with CAB and RPV-associated mutations) and one was lost-to-follow-up. At week 48, two of those with VF were suppressed on alternative regimens (lenacapavir+BIC/TAF/FTC and CAB+lenacapavir). Overall week 48 VS on either LA-CAB/RPV or alternative ART was 92% (54/59). Conclusions In PWH initiating LA-CAB/RPV with initial viremia, 48-week VS (<50 copies/mL) was 92%. Long-acting ART can be an important tool for improving VS among patients who face adherence challenges to oral ART.

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Letter to the Editor: Real-Life Experience of Long-Acting Cabotegravir–Rilpivirine Combination in a Person Living with HIV with Detectable Viremia: A Case Report

Cited by 2 publications

References 4 publications

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People with HIV Who Are Virally Unsuppressed

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People with HIV Who Are Virally Unsuppressed

Viral Suppression Rates at 48 Weeks in People With Human Immunodeficiency Virus Starting Long-Acting Cabotegravir/Rilpivirine With Initial Viremia

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