CAB+RPV LA Is Versatile, Preferred in Treatment-Naive Patients

The combination of long-acting cabotegravir with rilpivirine (CAB+RPV LA) has been used as a method of treating HIV. The injection can be received either monthly or every other month, potentially making it an appealing alternative to daily pills due to its persistent efficacy. In posters presented during the Conference on Retroviruses and Opportunistic Infections 2026, researchers evaluated whether treatment-naive patients prefer the CAB+RPV LA treatment to daily pills and how effective it was in patients with viral loads of 50 copies/mL or more compared with patients with less than 50 copies/mL.

One study¹ presented results from the VOLITION study (NCT05917509), the first to evaluate the optional switch to CAB+RPV LA from the combination of dolutegravir/lamivudine (DTG/3TC) when patients reached viral suppression on DTG/3TC. All participants of the VOLITION study were patients who were naive to treatment with antiretroviral therapy (ART). The results presented at the conference were from 11 months of the study.

Patients were enrolled if they were naive to ART and had a plasma HIV-1 RNA level of 1000 copies/mL or higher. The patients received DTG/3TC every day for up to 16 weeks as part of a Suppression Phase. Patients were offered the choice to switch to CAB+RPV LA starting at the fourth week when they were virologically suppressed. The CAB+RPV LA was offered on a 2-month dosing schedule and would start at the next study visit. The primary end point was the number of patients who switched their treatment, with a second primary end point being the proportion of patients with an HIV-RNA of less than 50 copies/mL in those who switched to CAB+RPV LA after 11 months.

A total of 129 (85%) of the 151 patients included in this study had switched to CAB+RPV LA after achieving virologic suppression, after which they were followed up through month 11. HIV-1 RNA of less than 50 copies/mL was found in 88% of those who had switched to the long-acting treatment compared with 5% of patients who had 50 copies/mL or more and 8% who had no data. The suppression rate was 95% through 11 months.

Patients cited avoiding missed doses (80%), convenience (64%), and not needing to travel with pills (68%) as the top reasons for switching, and treatment satisfaction was high with a score of 62.5 on the HIV Treatment Satisfaction Questionnaire through 11 months. Treatment-related adverse effects were reported in 10% of the participants.

“In VOLITION, rapid virologic suppression with DTG/3TC enabled an early, participant‑driven switch to long‑acting CAB+RPV without compromising efficacy,” said Bryn Jones, MSc, MBBS, vice president, Global Medical Lead at ViiV Healthcare and coauthor of the study. “This approach supported personalized treatment choices, with the vast majority of participants maintaining suppression after switching—demonstrating that early access to long‑acting therapy can align clinical outcomes with individual preferences.”

A second poster² also looked into the efficacy of CAB+RPV LA when used in patients who have viral loads of 50 copies/mL or more, or less than 50 copies/mL. The poster reported findings from patients enrolled in the OPERA study (NCT05495204) and stratified outcomes by viral load.

Patients enrolled in the study were those who had previously been treated and started CAB+RPV LA between January 21, 2021, and December 31, 2024. Patients who had at least 1 viral load measurement through February 28, 2025, and had received initiation injections 67 days or fewer apart were assessed for virologic outcomes. Suppression was maintained in those with less than 50 copies/mL if all measurements, or the last measurement, were less than 50 copies/mL. Patients had virologic failure if they had 2 measurements of 200 copies/mL or 1 measurement of 200 copies/mL accompanied by treatment discontinuation. Viral suppression was obtained in those who started with 50 copies/mL or more, as long as any measurement or the last measurement was less than 50 copies/mL.

There were 5264 participants in the study, of which 87% had a viral load of less than 50 copies/mL, and 11% of those who had a viral load of 50 copies/mL or more; 2% were missing viral load measurements. The first group had 58% of their participants receive their treatment on time, vs 56% of the second group. There were 1288 and 161 participants who had short delays, respectively in the first and second group (median, 3 and 4 days) and 354 and 40 who had long delays (median delay, 52 days). A total of 78% of the first group and 73% of the second group stayed on CAB+RPV LA at the last follow-up, with 81% suppressed at all follow-up VLs and 95% with a last VL of less than 50 copies/mL in the first group, and 87% achieving suppression and 79% with a last VL of less than 50 copies/mL in the second group.

The researchers concluded that CAB+RPV LA was equally effective in those with more or less than 50 copies/mL, as most participants remained suppressed through the last follow-up, and virologic failure only affected 1% to 2% of each group. The researchers offer CAB+RPV LA as a preferred treatment for any patient who does not like oral regimens and would prefer longer-acting medication to improve adherence.

References

1. Rolle CP, Hove K, Cahn P, et al. Early switch to CAB+RPV LA in treatment-naïve adults with HIV-1: month 11 outcomes from VOLITION. Presented at: Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO. Abstract 525.
2. Levis B, Sension M, Fusco J, et al. Outcomes for individuals who initiate CAP+RPV LA in OPERA with viral loads ≥50 vs <50 copies/mL. Presented at: Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO. Abstract 527.