Ring Kyle, Orkin Chloe
Blizard Institute, Centre for Immunology and Infectious Disease: Queen Mary University of London.
Barts Health NHS Trust, London, UK.
Curr Opin HIV AIDS. 2025 Jan 1;20(1):4-10. doi: 10.1097/COH.0000000000000897. Epub 2024 Nov 5.
Long-acting antiretroviral therapy (ART), such as with cabotegravir and rilpivirine, is a new and exciting paradigm shift that could change the face of HIV treatment if it were universally available to all who want it. In countries where there is access, uptake has been slow - partly because of capacity issues and partly because of hesitancy around remaining clinical questions. We summarized clinical trial data and emerging real-world evidence to shed light on these questions.
Phase 2b/3/3b clinical trials have shown CAB+RPV injections to be both well tolerated and efficacious. Real-world cohort (RWC) studies with larger numbers of people demonstrate high levels of adherence and persistence, and low rates of virological failure in clinical practice.
Although the risk of virological failure in the context of CAB+RPV is low, it remains a pertinent issue because of the high risk of developing two-class resistance. The use of multiple definitions of virological failure in RWC studies currently makes understanding the available evidence difficult and could have deleterious effects on clinical decision-making. Longer term real-world evidence in diverse populations is needed to better understand the durability of CAB+RPV and its suitability in different contexts.
长效抗逆转录病毒疗法（ART），如使用卡博特韦和rilpivirine，是一种全新且令人振奋的模式转变，如果能让所有有需求的人普遍使用，可能会改变HIV治疗的面貌。在有条件获取该疗法的国家，其采用率一直较低——部分原因是能力问题，部分原因是对尚存临床问题存在犹豫。我们总结了临床试验数据和新出现的真实世界证据，以阐明这些问题。
2b/3/3b期临床试验表明，卡博特韦+rilpivirine注射耐受性良好且有效。针对更多人群的真实世界队列（RWC）研究显示，在临床实践中依从性和持续性水平较高，病毒学失败率较低。
尽管在卡博特韦+rilpivirine治疗中病毒学失败风险较低，但由于产生两类耐药性的风险较高，这仍是一个相关问题。目前RWC研究中对病毒学失败采用多种定义，使得理解现有证据变得困难，并且可能对临床决策产生有害影响。需要在不同人群中获取更长期的真实世界证据，以更好地了解卡博特韦+rilpivirine的持久性及其在不同情况下的适用性。
