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Opinion|Videos|May 16, 2025

Long-Acting HIV Therapies: Real-World Data and Clinical Application

A panelist discusses how the injectable combination of cabotegravir and rilpivirine performed well in the real-world OPERA cohort, with over 95% of patients maintaining virologic suppression. However, adherence to injection schedules remains a challenge, with only 62% receiving injections on time.

Episodes in this series

Long-Acting Injectable Therapy – Real-World Evidence

Key Themes:

  • Injectable Option: Cabotegravir (integrase inhibitor) plus rilpivirine as an intramuscular injection given every other month
  • Real-World Performance: The OPERA cohort followed nearly 3000 US patients receiving this combination outside clinical trials.
  • Adherence Challenges: Importance of timely injections, with 62% of patients receiving injections on schedule and 12% missing injections
  • Clinical Implications: Risk of resistance development if injections are delayed or missed

Notable Insights from Dr Sharon Walmsley:

  • Real-world virologic suppression rates exceeded 95%, with less than 1% experiencing virologic failure, mirroring clinical trial results.
  • High body mass index was not associated with treatment failure in this cohort, contrasting with some earlier studies, likely due to improved administration techniques (longer needles).
  • Injectable therapy offers psychological benefits to patients who are “tired of swallowing pills” or find daily oral medication a constant reminder of HIV status.
  • Clinics need systematic approaches to track and ensure timely administration of injections to prevent resistance development.

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