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Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges.

Aadia I Rana1, Lu Zheng2, Jose Castillo-Mancilla3,4

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|February 18, 2026
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Summary
This summary is machine-generated.

Monthly long-acting injectable antiretroviral therapy (ART) with cabotegravir-rilpivirine significantly reduced regimen failure in people with HIV who struggle with oral medication adherence. This injectable ART offers a superior alternative for improved treatment outcomes.

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Area of Science:

  • Infectious Diseases
  • Virology
  • Clinical Trials

Background:

  • Limited randomized trials exist for long-acting injectable antiretroviral therapy (ART) in HIV patients with adherence challenges.
  • Adherence to oral ART is crucial for managing HIV but remains a significant barrier for some individuals.
  • Exploring alternative ART formulations is vital for improving treatment efficacy and patient outcomes in HIV management.

Purpose of the Study:

  • To evaluate the efficacy of monthly long-acting injectable cabotegravir-rilpivirine compared to standard oral ART.
  • To assess regimen failure rates in individuals with HIV experiencing adherence difficulties with oral medications.
  • To determine the safety and tolerability of long-acting injectable ART in a randomized controlled trial setting.

Main Methods:

  • An open-label, randomized trial enrolled 453 participants with inadequate adherence to oral ART.
  • Participants received adherence support and incentives, with those achieving viral suppression randomized to injectable cabotegravir-rilpivirine or standard oral ART.
  • The primary outcome was regimen failure, defined as virologic failure or treatment discontinuation over 48 weeks.

Main Results:

  • Injectable cabotegravir-rilpivirine demonstrated superior efficacy, with a regimen failure rate of 22.8% versus 41.2% for standard care.
  • The incidence of adverse events was comparable between the injectable and oral ART groups.
  • Resistance-associated mutations were observed in a small number of participants in both groups.

Conclusions:

  • Monthly long-acting injectable cabotegravir-rilpivirine is superior to standard oral ART for individuals with HIV and adherence challenges.
  • Injectable ART offers a promising alternative for improving treatment adherence and reducing regimen failure in this population.
  • The findings support the use of long-acting injectable ART as a viable strategy in HIV management.