Hickey Matthew D, Gistand Nathanael, Grochowski Janet, Mayorga-Munoz Francis, Imbert Elizabeth, Szumowski John D, Oskarsson Jon, Shiels Mary, Dilworth Samantha, Appa Ayesha, Havlir Diane V, Gandhi Monica, Christopoulos Katerina
Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, California, USA.
Division of Infectious Disease, San Francisco VA Medical Center, University of California, San Francisco, California, USA.
Clin Infect Dis. 2025 Apr 30;80(4):864-870. doi: 10.1093/cid/ciae500.
We previously demonstrated at the Ward 86 human immunodeficiency virus (HIV) clinic in San Francisco that long-acting (LA) cabotegravir (CAB)/rilpivirine (RPV) (LA-CAB/RPV) can rapidly lead to viral suppression in people with HIV (PWH) with viremia due to adherence challenges. We now evaluate the durability of viral suppression in this population.
We conducted a retrospective cohort study of PWH who started LA-CAB/RPV with viremia (HIV RNA viral load ≥50 copies/mL) before December 2022. Our primary outcome was viral suppression (viral load <50 copies/mL) with LA-CAB/RPV persistence (not discontinued or late by >14 days) at 48 weeks, using the viral load closest to 48 ± 8 weeks. We also describe viral failure, defined as a <2-log decline in viral load at 4 weeks or a viral load ≥200 copies/mL after initial viral suppression with emergent CAB- or RPV-associated resistance mutations; overall 48-week viral suppression including those switched to alternative antiretroviral therapy (ART).
Fifty-nine PWH initiated LA-CAB/RPV with viremia and were included in the analysis; 49% had a CD4 cell count <200/µL, and the median baseline viral load was 42 900 copies/mL (quarter 1-quarter 3, 5272-139 038). At 48 weeks, 47 PWH met the primary outcome of viral suppression with LA-CAB/RPV persistence (80% [95% confidence interval, 67%-89%]). Five had viral failure with resistance (3 with RPV-associated and 2 with CAB- and RPV-associated mutations), and 1 was lost to follow-up. At week 48, 2 of those with viral failure were suppressed on alternative regimens (lenacapavir + bictegravir/tenofovir alafenamide/emtricitabine and CAB + lenacapavir). The overall viral suppression at week 48 with either LA-CAB/RPV or alternative ART was 92% (54 of 59).
In PWH initiating LA-CAB/RPV with initial viremia, 48-week viral suppression (<50 copies/mL) was seen in 92%. LA ART can be an important tool for improving viral suppression among patients who face adherence challenges to oral ART.
我们之前在旧金山86区的人类免疫缺陷病毒（HIV）诊所证明，长效卡博特韦（CAB）/利匹韦林（RPV）（LA-CAB/RPV）可迅速使因依从性问题导致病毒血症的HIV感染者（PWH）实现病毒抑制。我们现在评估该人群中病毒抑制的持久性。
我们对2022年12月前开始使用LA-CAB/RPV且存在病毒血症（HIV RNA病毒载量≥50拷贝/mL）的PWH进行了一项回顾性队列研究。我们的主要结局是在48周时实现病毒抑制（病毒载量<50拷贝/mL）且LA-CAB/RPV持续使用（未停药或延迟超过14天），使用最接近48±8周的病毒载量。我们还描述了病毒学失败，定义为在4周时病毒载量下降<2个对数或在初始病毒抑制后病毒载量≥200拷贝/mL，同时出现与CAB或RPV相关的耐药突变；48周时的总体病毒抑制情况，包括那些换用替代抗逆转录病毒疗法（ART）的患者。
59例存在病毒血症的PWH开始使用LA-CAB/RPV并纳入分析；49%的患者CD4细胞计数<200/µL，基线病毒载量中位数为42900拷贝/mL（四分位数1 - 四分位数3，5272 - 139038）。在48周时，47例PWH达到了病毒抑制且LA-CAB/RPV持续使用的主要结局（80%[95%置信区间，67% - 89%]）。5例出现病毒学失败并伴有耐药（3例与RPV相关，2例与CAB和RPV相关突变），1例失访。在第48周时，2例病毒学失败的患者在替代方案（来那卡韦 + 比克替拉韦/替诺福韦艾拉酚胺/恩曲他滨和CAB + 来那卡韦）下实现了病毒抑制。在第48周时，使用LA-CAB/RPV或替代ART的总体病毒抑制率为92%（59例中的54例）。
在初始存在病毒血症并开始使用LA-CAB/RPV的PWH中，92%的患者在48周时实现了病毒抑制（<50拷贝/mL）。长效抗逆转录病毒疗法可以成为改善口服抗逆转录病毒疗法依从性面临挑战的患者病毒抑制情况的重要工具。
