Most Patients With HIV Opted for Injectable ART, PrEP in Phase 3 Trial

Long-acting injectable cabotegravir (Vocabria; ViiV Healthcare) and rilpivirine (Rekambys; ViiV Healthcare) (CAB+RPV) for use as antiretroviral therapy (ART) was preferred by patients in the phase 3b VOLITION study, which included treatment-naive people living with HIV who had achieved rapid viral suppression with daily doses of dolutegravir/lamivudine (DTG/3TC) (Dovato; ViiV Healthcare).¹ Individuals were also mostly satisfied with switching to long-acting cabotegravir for use as pre-exposure prophylaxis (PrEP) from daily oral medication.

Participants were likely to prefer long-acting injectable versions of both ART and PrEP | Image credit: Pepermpron - stock.adobe.com

CAB+RPV is an injection of ART used to treat HIV in adults and adolescents aged at least 12 years who are already virally suppressed with no prior indications of treatment resistance. CAB+RPV is also available in tablets to lead into the long-acting injectable treatment or as an alternative to injections.² DTG/3TC has been used to treat HIV as an ART in those with no history of ART or as a replacement for a current regimen in those with no history of treatment failure. Cabotegravir on its own has been approved in the past for use as bimonthly treatment of PrEP, requiring 7 doses in the first year of use and 6 per year thereafter. The approval of cabotegravir marked the first ever long-acting injectable PrEP available to those at increased risk of HIV.²

The phase 3b VOLITION study aimed to assess whether patients who started using daily DTG/3TC treatment would switch to long-acting CAB+RPV when offered after achieving viral suppression.¹ Viral suppression was achieved in these patients in a median time of 4.14 weeks. A total of 89% of the 145 participants agreed to switch to long-acting CAB+RPV compared with 11% who continued with DTG/3TC. Not missing a dose (80%) and not having to carry medication (68%) were the primary reasons for the switch according to patients.

Long-acting injectables were also preferred when looking at studies that focused on PrEP. The PILLAR and EBONI studies found that long-acting injectable cabotegravir was an effective method of PrEP. The phase 4 results for PILLAR found that the long-acting injectable was acceptable (mean, 4.6/5 after 12 months) and feasible (mean, 4.4/5 after 12 months). Patients were happy with the switch from oral PrEP to cabotegravir, with 95% of them reporting satisfaction and 98% recommending the treatment. The participants also noted lower concerns around stigma when taking the injectable treatment compared with oral PrEP.

The EBONI study focused on the feasibility and appropriateness of long-acting cabotegravir for PrEP in Black cis- and transgender women across 72 health care provider respondents at 15 primary care and infectious disease clinics in the US. The EBONI study had similar mean scores as the PILLAR study, with a mean score of 4.5/5 for being highly appropriate and a mean score of 4.4/5 for being feasible. Additional opportunities to screen for sexually transmitted diseases and comorbidities was also a health benefit of the monthly visits.

Overall, patients preferred having long-acting alternatives to taking ART and PrEP as a means of reducing the number of doses necessary to keep up their treatment. Long-acting cabotegravir for use as PrEP allowed time for other screening while the patient was in the clinic to receive their dose and long-acting CAB+RPV reduced the need to carry medication, which could help in reducing feelings around stigma. These results emphasize the need for doctors to offer these methods of treatment to their patients in order to better suit the needs of their patients and increase adherence.

“ViiV is proud to have pioneered long-acting injectables for HIV, which are a key part of HIV treatment and prevention, and we now have over 3 years of robust real-world evidence demonstrating the impact our portfolio is having today across a broad range of settings and populations,” said Jean van Wyk, MBChB, MFPM, chief medical officer at ViiV Healthcare. “Data from the VOLITION study highlight how providing choice in HIV care empowers individuals to choose medicines that meet their evolving everyday needs. As long-acting injectables provide options that can offer high effectiveness and tolerability, improved adherence, and a preferred dosing schedule compared with daily oral pills, we believe they will play a critical role in achieving our ambition of ending HIV and AIDS.”

References

1. ViiV Healthcare data show 89% of treatment-naïve people with HIV choose to switch to long-acting injectable Vocabria + Rekambys from daily pills after achieving rapid viral suppression. News release. ViiV Healthcare. July 14, 2025. Accessed July 15, 2025. https://viivhealthcare.com/hiv-news-and-media/news/press-releases/2025/july/daily-pills-after-achieving-rapid-viral-suppression/

2. AJMC Staff. FDA approves long-acting, injectable cabotegravir to prevent HIV. AJMC^®. December 24, 2021. Accessed July 15, 2025. https://www.ajmc.com/view/fda-approves-long-acting-injectable-cabotegravir-to-prevent-hiv