Long-acting antiretroviral therapy injections maintain viral suppression in people living with HIV

1. In this observational study, long-acting antiretroviral therapy (LA-ART) was effective at maintaining virologic suppression in persons living with human immunodeficiency virus (PLWH) with preexisting suppression.

2. Long-acting antiretroviral therapy was also effective at demonstrating virologic suppression in PLWH with viremia. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Daily oral ART for the treatment of human immunodeficiency virus (HIV) is currently the cornerstone of maintaining viral suppression. Despite its effectiveness, significant structural and systemic barriers exist that impact adherence to daily oral ARTs. These include unstable housing and difficulties accessing medical services. Accordingly, long-acting agents may be particularly beneficial in improving ART adherence rates and reducing barriers to treatment amongst patients for whom daily oral ART is challenging. This was a single-site observational study evaluating the effectiveness of LA-ART in the treatment of HIV amongst a population within San Francisco. Results of the study found that LA-ART was effective at both achieving viral suppression within participants who have preexisting viremia, and maintaining suppression within participants who demonstrated viral suppression prior to initiating LA-ART. The primary limitations of this study were the relatively small sample size of included participants, the reproducibility of rolling out a program such as this at other centers which may lack preexisting infrastructure, and the lack of assessment of the long-term effects of LA-ART. Overall, this study added to the body of evidence demonstrating the benefits of LA-ART in a real-life population.

Click to read the study in AIM

In-Depth [observational cohort study]: This was an observational cohort study of adult PLWH at a community-embedded HIV clinic evaluating the effectiveness of LA-ART. The primary outcome was the effectiveness of viral suppression maintenance amongst those with preestablished suppression, and induction of viral suppression for those with viremia. Participants were recruited through the Ward 86 HIV Clinic in San Francisco via the Supporting Positive Living and Sexual Health program. Specifically, participants with an interest in initiating approved LA-ART, an ability to visit the clinic regularly, and difficulties with maintenance on daily oral ART were included. Participants with known resistance mutations were excluded. After the application of the inclusion and exclusion criteria, 133 participants were started on LA-ART with a combination of intramuscular carbotegravir and rilpivirine. The primary results of the analysis found that 100% of participants who demonstrated virologic suppression prior to initiating LA-ART maintained their suppression (95% Confidence Interval [CI], 95% to 100%). Out of participants who demonstrated viremia prior to starting LA-ART, 97.5% were estimated to attain virologic suppression at the end of the follow-up period. The results of this study added positively to the growing body of literature in support of the effectiveness of LA-ART, particularly among individuals for whom maintenance with oral ART may be challenging.

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