1592. Real-World Utilization and Effectiveness of Long-Acting Cabotegravir + Rilpivirine Among People with HIV with Detectable Viral Loads at Initiation: Trio Cohort Study
Authors: Elion Rick A , Frick Andrew , Radtchenko Janna , Sridhar Gayathri , Sarkar Supriya , Eron Joseph J , Mounzer Karam , van Wyk Jean A , Vannappagari Vani 
Published: November 2023

Abstract

Background
Cabotegravir+Rilpivirine (CAB+RPV) is the first FDA-approved complete long-acting (LA) injectable antiretroviral therapy (ART) for treatment of HIV-1 infection among ART-experienced, virologically suppressed (VL &lt; 50 c/mL) people with HIV (PWH). We assessed utilization and effectiveness among PWH with VL ≥ 50 c/mL at initiation in real world clinical setting.

Methods
Adult PWH who received ≥ 1 CAB+RPV injections through March 2023 with VL ≥ 50 c/mL at initiation were identified using electronic medical records from Trio Health HIV Network. Results were stratified by VL ≥ 50 c/mL and ≥ 200 c/mL at initiation. Genotypic resistance data prior to initiation of CAB+RPV LA was available for a subset of individuals, with resistance interpretation described using Stanford HIVdb algorithm.

Results
Among 329 PWH with ≥ 1 CAB+RPV injections, 29 (9%) had VL ≥ 50 c/mL at initiation. All were treatment-experienced and 12 (41%) had VL ≥ 200 c/mL, median log VL 3.1 (IQR: 2.3, 5.0) at initiation; 21% were women, 48% were Black, median age was 43 (IQR: 34, 48), and 41% had a BMI ≥ 30.
At the time of analysis, all individuals remained on CAB+RPV LA with median follow-up of 4.0 months (IQR: 2.2, 9.2) with median 3 injections (IQR 1, 5); 20 individuals had ≥ 2 injections and 16 had ≥ 3, with 80/86 (93%) follow-up injections administered within target window. Median time from first to second injection was 32 days (IQR: 30, 36), and median time from second to third injection was 59 days (IQR: 30, 62). Among the 16 individuals with ≥ 3 injections, 12 were on every-2-month dosing schedule.
Sixteen (55%) individuals had a follow-up VL. Of them, the last VL was &lt; 50 c/mL in 12 individuals (75%), &lt; 200 c/mL in 15 (94%), and 1 with VL 1202 c/mL (pre-index VL 2138 c/mL).
Historical HIV genotype results were available for 15 individuals (52%). One individual had low-level resistance to CAB based on Y143R mutation and this individual had a follow-up VL &lt; 50 c/mL. Five individuals had NNRTI mutations, one with low-level resistance to RPV and a follow-up VL &lt; 200 c/mL.

Conclusion
This real-world data of individuals who received ≥ 1 CAB+RPV LA injections with VL ≥ 50 c/mL at initiation demonstrated high rates of virologic suppression. Future analysis with longer follow-up will allow for evaluation of long-term outcomes.

Disclosures
Rick A. Elion, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Proteus: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Andrew Frick, MS, Trio Health Inc.: Employee Janna Radtchenko, MBA, Trio Health: Employee Gayathri Sridhar, MBBS, MPH, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Full Time Employee Supriya Sarkar, PhD, MPH, ViiV Healthcare: Employee Joseph J. Eron, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Karam Mounzer, MD, Clinical Care Options: Speakers Bureau|Epividian: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Speakers Bureau|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Janssen: Speakers Bureau|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Speakers Bureau|Prime: Speakers Bureau|Simply Speaking: Speakers Bureau|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Speakers Bureau Jean A. van Wyk, MBChB, MFPM, ViiV Healthcare Ltd: Stocks/Bonds Vani Vannappagari, MBBS, MPH, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee