Back Back
IDWeek 2024: Long-Acting Injectables for HIV
IDWeek 2024: Clinical Studies and Real-world Evidence of Long-Acting Injectables for HIV

Released: November 19, 2024

Expiration: November 18, 2025

Meredith E. Clement
Meredith E. Clement, MD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Evidence is growing that there may be a place for long-acting antiretroviral therapy in multidrug resistant HIV, in people with adherence challenges, and in pharmacy settings.

IDWeek 2024, held in Los Angeles, California, was filled with exciting new data discussed by experts from across the world. Key findings from recent studies with a focus on long-acting (LA) injectables are highlighted here.

Lenacapavir (LEN) for Multidrug-Resistant HIV
Dr Onyema Ogbuagu presented 3-year results from the phase II/III randomized, double-blinded, placebo-controlled, global, multicenter CAPELLA trial of LEN for the treatment of multidrug-resistant HIV. Reassuringly, 61.4% of participants had viral suppression at Week 156 (2 participants were excluded from the analysis because of missing HIV-1 RNA), no new cases of LEN resistance occurred in this extended analysis between Week 104 and Week 156 (14 developed resistance prior to Week 104), and LEN continued to be well tolerated. Although new cases of multidrug-resistant HIV are hopefully few and far between, it is helpful to know that LEN combined with an optimized background regimen may be an adjunctive therapy option in people with multidrug resistant HIV.

Real-world Evidence of LA Injectables
Dr Jessica Altamirano presented real-world evidence on LEN in 24 patients from a network of clinics throughout the US. LEN was offered for regimen simplification, side effects or intolerance to other antiretroviral therapy (ART), and nonadherence, with 8 patients (33%) having a pre-LEN viral load (VL) of >50 copies/mL. Fortunately, all 8 patients achieved viral suppression after LEN initiation.

Additional real-world evidence came from Dr Elizabeth Hastie, who presented data from UC San Diego on persons with adherence challenges (virologic failure or lost to follow-up) who were started on LA cabotegravir and rilpivirine (CAB/RPV). At 48 weeks, 81.5% (44/54) remained on LA CAB/RPV and had continued VL suppression. Dr Hastie emphasized that “the people who have the most to gain from LA ART are those with adherence issues who cannot achieve virologic suppression with oral therapy”—and, to me, this is so true. These new injectable regimens are a remarkable tool but are mostly being utilized only by those who have the resources and ability to adhere to oral therapy, representing a missed opportunity. Dr Hastie’s study provides additional evidence that LA injectables could be expanded to unsuppressed populations. 

In further support of this idea, a small study led by Dr James Brock from the University of Mississippi Medical Center provided preliminary data on the use of LA CAB/RPV + LEN for unsuppressed patients with adherence challenges and resistance-associated mutations to CAB or RPV. All 9 participants maintained suppression for 24 to 36 weeks. Additional data on this combination are needed, but this study adds to evidence from a previously published case series of 34 patients, most with integrase strand transferase inhibitor (INSTI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, who were placed on CAB and LEN +/- RPV. Overall, 94% of patients achieved viral suppression.

LA CAB for Pre-Exposure Prophylaxis (PrEP)
Finally, it is important to mention the study of a pharmacy-run PrEP program featuring LA CAB discussed by Dr Elyse Tung. Out of 50 participants who initiated LA CAB for PrEP, 94% received on-time injections and 81% had persistence in care at 26 weeks, similar to other real-word studies on LA CAB. These early data offer encouraging evidence that LA PrEP can be administered in nontraditional settings, an important strategy that I believe can reduce barriers and expand access for those who can benefit most from PrEP.

Your Thoughts?
What do you think of the evidence for LA ART in people with adherence challenges? Get involved in the discussion by answering the polling question and posting a comment below.