Use of long-acting therapies for the HIV treatment in the Spanish pediatric cohort (CoRISpe).

INTRODUCTION

Adolescents and young adults living with HIV (AYHIV) face complex psychosocial and adherence challenges that compromise long-term treatment success. Long-acting injectable therapies (LA-ART), such as cabotegravir and rilpivirine, may improve adherence, reduce stigma, and facilitate treatment retention.

METHODS

We conducted a retrospective, multicenter study of AYHIV enrolled in the Spanish pediatric HIV cohort (CoRISpe) and its adult extension (CoRISpe-FARO), who initiated LA-ART. Demographic, clinical, virological, immunological and biochemical data were analyzed up to March 2025. Outcomes before and after LA-ART initiation were analyzed, including CD4/CD8 ratio, viral suppression, and body mass index (BMI).

RESULTS

Among 681 individuals in active follow-up, 26 AYHIV (65.4% women, median age 28) initiated LA-ART, primarily for treatment simplification. Most had acquired HIV perinatally and had extensive ART histories; 30% had received more than ten different ART regimens. Twenty-one patients had documented virological failures prior to LA-ART. Despite this, all patients achieved or maintained virological suppression after a median follow-up of 11 months. This included three individuals who initiated LA-ART with detectable viral load. CD4 and CD8 counts remained stable; the CD4/CD8 ratio showed an upward trend (p = 0.057), suggesting improved immune balance. Notably, AYHIV with BMI < 30 kg/m² showed significant increases in CD4 count, CD4%, and CD4/CD8 ratio. Overall BMI increased post-LA-ART (p = 0.036), especially in women. Treatment was well tolerated, with only one discontinuation due to injection site pain.

CONCLUSIONS

LA-ART was safe, well tolerated, and effective in maintaining virological suppression, and showed positive immunological trends in AYHIV, including those with prior adherence issues or detectable viral load at baseline. These results support the potential of LA-ART as a valuable therapeutic strategy in AYHIV, especially in those with complex treatment histories and adherence challenges. Further prospective studies are warranted to confirm long-term outcomes.