Experience of treatment with long-acting injectable cabotegravir/rilpivirine (LA iCAB/RPV) in viremic young patients with perinatally acquired HIV with adherence challenges: A five-case series.

BACKGROUND AND

OBJECTIVES

Long-acting injectable antiretroviral therapy (ART) has transformed HIV care by reducing the burden of daily medication and improving adherence. While primarily approved for virologically suppressed individuals, emerging evidence supports its use in viremic patients with complex treatment histories. However, real-world evidence remains limited, especially in youth with perinatally acquired HIV. This case series provides further insights into the use of long-acting ART in this group.

PATIENTS AND

METHODS

This case series presents five young adults (aged 20-31) with perinatally acquired HIV (PHIV) and long-term ART failure, followed at Hôtel-Dieu University Hospital in Paris. All were transitioned to long-acting intramuscular cabotegravir and rilpivirine (LA iCAB/RPV); one also received a single injection of lenacapavir at initiation.

RESULTS

Patients had been on ART for a mean of 20 years and exposed to an average of seven prior regimens. Most had experienced HIV-related complications, and four showed resistance mutations to existing treatments. Despite baseline viremia and complex treatment histories, four of five achieved virologic suppression (<1.3 log RNA copies/ml) within 3 months of initiating LA iCAB/RPV and one patient within 9 months. One patient later experienced a modest viral rebound (1.8 log copies/ml) after 14 months of control. Two patients missed scheduled injections but were successfully reinduced using the loading dose protocol. Treatment was well tolerated, with no adverse events.

CONCLUSIONS

LA iCAB/RPV appears to be a promising treatment strategy for youth with perinatally acquired HIV facing persistent adherence barriers and previous treatment failures. Further studies with larger cohorts and extended follow-up are needed to confirm these results and inform care strategies.