Viguerie Alex, O'Shea Jesse, Johnston Marie, Schreiber Daniel, Adams Joella, Bates Laurel, Carrico Justin, Hicks Katherine A, Lyles Cynthia M, Farnham Paul G
Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
College of Pharmacy, University of South Carolina, Columbia, SC.
AIDS. 2025 Jul 1;39(8):1024-1031. doi: 10.1097/QAD.0000000000004144. Epub 2025 Feb 4.
To determine the impact of increased long-acting injectable antiretroviral therapy [cabotegravir-rilpivirine (CAB/RPV)] use among persons with diagnosed HIV (PWDH) with viral suppression (VLS), per 2021 US Food and Drug Administration (FDA) guidelines, on HIV incidence and levels of VLS in the United States.
We used the HOPE compartmental model to simulate CAB/RPV use during 2023-2035. We first simulated a baseline scenario (no CAB/RPV), in which 69% of PWDH had VLS. We then introduced CAB/RPV in 2023 under two scenarios: where CAB/RPV improved the duration of VLS postcessation of ART use compared to oral ART; where CAB/RPV additionally improved adherence. We compared cumulative 2023-2035 incidence and percentage of PWDH with VLS at year-end 2035 to baseline.
When CAB/RPV increased the duration of VLS only, cumulative incidence was reduced up to 9%, and VLS increased up to 4%. When CAB/RPV also improved ART adherence, incidence was reduced up to 19.5%, and VLS increased up to 9%.
CAB/RPV, even if only used among PWDH with VLS, may reduce HIV incidence and increase VLS, due to longer-lasting VLS postcessation of usage. If CAB/RPV also improves ART adherence, incidence is further reduced. Improved clinical efficacy of CAB/RPV may translate to improved population-level outcomes, even in limited use cases.
根据2021年美国食品药品监督管理局（FDA）的指南，确定在病毒得到抑制（VLS）的已确诊HIV感染者（PWDH）中增加长效注射用抗逆转录病毒疗法[卡博特韦-利匹韦林（CAB/RPV）]的使用，对美国HIV发病率和VLS水平的影响。
我们使用HOPE房室模型来模拟2023年至2035年期间CAB/RPV的使用情况。我们首先模拟了一个基线情景（不使用CAB/RPV），其中69%的PWDH实现了VLS。然后在2023年引入CAB/RPV，设置了两种情景：与口服抗逆转录病毒疗法相比，CAB/RPV可改善抗逆转录病毒治疗（ART）停药后VLS的持续时间；CAB/RPV还可额外提高依从性。我们将2023年至2035年的累积发病率以及2035年年末实现VLS的PWDH百分比与基线进行了比较。
当CAB/RPV仅延长VLS的持续时间时，累积发病率降低了9%，VLS增加了4%。当CAB/RPV还提高了ART依从性时，发病率降低了19.5%，VLS增加了9%。
由于停药后VLS持续时间更长，即使仅在实现VLS 的PWDH中使用CAB/RPV，也可能降低HIV发病率并提高VLS水平。如果CAB/RPV还能提高ART依从性，则发病率会进一步降低。即使在有限的使用案例中，CAB/RPV临床疗效的改善也可能转化为人群水平结局的改善。
