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LA HIV at IDWeek
LA Story: Anticipating Long-Acting HIV Data at IDWeek 2024

Released: October 14, 2024

Expiration: October 13, 2025

Darcy Wooten
Darcy Wooten, MD, MS
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Key Takeaways
  • At IDWeek 2024, I expect many forms of long-acting ART to steal the show, with updates on their potential for treatment in multidrug-resistant HIV, for providing new options for uptake and adherence in key populations, and for HIV prevention. 

Long-acting (LA) antiretroviral therapy (ART) has been a game-changer for many people with HIV and people wanting to prevent HIV. It promises to provide additional options for those with multidrug resistance and those with pill fatigue or adherence barriers to daily medication. 

Treatment for Multidrug-Resistant HIV
At IDWeek 2024, it will be exciting to see updated results from the CAPELLA study in which treatment-experienced people with multidrug-resistant HIV were given subcutaneous lenacapavir every 6 months in addition to an optimized background regimen (see IDWeek Abstract 155). Previous updates from CAPELLA have shown relatively high rates of virologic suppression despite substantial drug resistance in this population.

It will be important to keep an eye on lenacapavir emergent resistance to understand the limitations of this strategy. We will also learn about real-world experiences with lenacapavir plus optimized background regimen from an observational study looking at its use and outcomes for people with multidrug-resistant HIV from a community-based clinic network (Abstract P-560). 

Uptake and Adherence in Key Populations
I am also looking forward to more data on injectable LA cabotegravir and rilpivirine (CAB/RPV), including its use in people with viremia and adherence challenges, in novel combinations, and in understudied populations.

The ground-breaking LATITUDE trial, presented at CROI 2024, showed that LA CAB/RPV was superior to continuing daily oral ART in people with adherence barriers. Of importance, participants in this study were initially provided financial incentives to adhere to daily oral therapy to facilitate virologic suppression before a planned switch to LA CAB/RPV. This strategy of using financial incentives will be difficult, if not impossible, to implement in clinical practice. At IDWeek 2024, Abstract 157 will present data on outcomes from people with adherence barriers who were started on LA CAB/RPV (including in the setting of viremia) without contingency management incentives. These data will be important to better characterize this regimen for this specific population.

I am also eager to see more data on the off-label combination of LA lenacapavir every 6 months with LA CAB/RPV in people with viremia and adherence barriers (Abstract P-558). I believe this treatment strategy is most applicable for people who struggle to take daily medication and who are suboptimal candidates for LA CAB/RPV alone owing to nonnucleoside reverse transcriptase inhibitor resistance. Gandhi and colleagues described the first case series with this off-label combination at CROI 2024, and additional data will help us to understand the strengths and limitations of this approach. 

Several abstracts will present data on LA CAB/RPV in understudied populations and settings. Poster 555 will describe outcomes of this regimen in people with HIV who have undergone renal transplantation. These data will be extremely helpful given the drug–drug interactions and pill burden this population experiences. I am also excited to see novel implementation strategies that increase uptake of LA CAB/RPV including CAB/RPV administration at a syringe exchange clinic for people who inject drugs (P-535).

Finally, I am excited to see the 48-week data of the phase II study of once-weekly oral islatravir plus lenacapavir (Abstract 577). In this open-label study, people whose HIV was suppressed on bictegravir/emtricitabine/tenofovir alafenamide were randomized to continue their current regimen or switch to weekly oral islatravir plus lenacapavir. This regimen could be an option for people interested in LA therapy but who want to avoid injections. In addition, because islatravir and lenacapavir have novel mechanisms of action, people are unlikely to have resistance to both agents. It will be important to keep on eye on absolute lymphocyte counts and CD4+ cell counts in people receiving islatravir, as previous studies with higher doses of islatravir led to significant declines in these indices. 

HIV Prevention
Although HPTN 083 and 084 have demonstrated a substantial benefit for HIV prevention with injectable LA CAB compared with daily oral pre-exposure prophylaxis (PrEP), use and uptake of LA CAB for PrEP remains extremely low. Abstract 507 will provide updated data on major gaps and unmet needs in PrEP care to help us to better design and target our interventions.

Several abstracts at IDWeek 2024 will provide LA CAB PrEP effectiveness data from clinical practice including results from the TRIO Health and OPERA cohorts (Abstracts 505 and 508). I am also eager to see data from novel implementation strategies for LA CAB PrEP including pharmacy-administered strategies (Abstract 507).

Learn More
As the IDWeek conference unfolds, I encourage you to check the Clinical Care Options website for downloadable slides summarizing the data from key studies like these. Also, plan to join me for live webinars as my colleagues and I provide our take on the clinical implications of the data. After the meeting, look for more ClinicalThought commentaries featuring expert perspectives on integrating new data into practice around the world.

Your Thoughts?
What HIV study are you most excited to see presented at IDWeek this year? You can get involved with the discussion by posting a comment below.