Long-Acting Cabotegravir/Rilpivirine, Lenacapavir, and Ibalizumab Use Among Persons With HIV-1 Viremia at a Ryan White-Funded Clinic in the Urban US South.

BACKGROUND

People with HIV (PWH) with viremia despite oral antiretroviral therapy (ART) can achieve viral suppression (VS) using long-acting (LA)-ART. Scaling this approach has lagged, especially in the highest HIV burden areas.

METHODS

We performed a retrospective review of PWH who initiated LA-ART (cabotegravir/rilpivirine [CAB/RPV] ± lenacapavir [LEN] ± ibalizumab [IBA]) with viremia (≥50 c/mL) at a Ryan White-funded program in the urban South between 14 April 2021 and 31 August 2024. Among PWH who received ≥3 LA-CAB/RPV injections through end of follow-up (31 December 2024), achieving VS (<50 c/mL) was assessed.

RESULTS

Eighty-one PWH with viremia initiated LA-ART. Among them, 93% identified as Black, 40% were cis-/trans-women, the median (Q1-Q3) age was 38 (30-49) years, and the median income was $25K/year ($20-33K/year). The median (Q1-Q3) time since HIV diagnosis was 15.5 (8.8-20.5) years, and 46% had prior opportunistic conditions. At LA-ART initiation (56 CAB/RPV; 22 CAB ± RPV + LEN; 3 CAB ± RPV + LEN + IBA), the median (Q1-Q3) viral load was 4.0 (2.9-4.8) log10 and CD4 + 186 (62-420) cells/μL. Of 79 PWH who remained engaged, 73 (92%) achieved VS after a median (Q1-Q3) of 1 (1-2) injection, with CD4 rise to 353 (187-501) cells/μL. Otherwise, 2 had virologic failure with drug resistance; 4 had persistent viremia without resistance (>200 c/mL [n = 2]; 50-200 c/mL [n = 2]). Of 645 LA-CAB/RPV injections (500 Q4wk; 145 Q8wk), 635 (98%) were administered on-time; all LEN (43/43) and IBA (37/37) administrations occurred on-time.

CONCLUSIONS

In the largest southern US cohort of PWH with viremia initiating LA-ART, 92% achieved VS despite significant barriers to care and disease burden, underscoring LA-ART as a tool to help achieve Ending the HIV Epidemic goals.