CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

683

Why Do People With HIV Stop Long-Acting Injectable Cabotegravir/ Rilpivirine and What Happens? Katerina Christopoulos, Matt Hickey, Janet Grochowski, Francis Mayorga-Munoz, Xavier Erguera, Samantha Dilworth, Elizabeth Imbert, Ayesha Appa, Matthew A. Spinelli, Chesa Cox, Mary Shiels, Jon Oskarsson, Monica Gandhi University of California San Francisco, San Francisco, CA, USA Background: We sought to examine reasons for discontinuation of long-acting injectable cabotegravir/rilpivirine (LA-CAB/RPV) and subsequent clinical outcomes in a cohort of people with HIV (PWH) in routine care. Methods: We conducted a retrospective chart review of PWH who initiated LA-CAB/RPV at Ward 86 in San Francisco through April 2024, censoring data on September 23, 2024. We coded free text notes using content analysis and summarized demographic and clinical characteristics overall and stratified by viral suppression (VS) vs. viremia, defined as HIV viral load (VL) < vs. ≥30 copies/mL) at LA-CAB/RPV initiation. We defined discontinuation as intended cessation of LA-CAB/RPV without documented plan to resume or loss to follow up (LTFU). VS post-discontinuation was defined as VL<200 copies/mL. Results: Of 346 PWH, 50 (14%) discontinued, of whom 17 (34%) initiated LA-CAB/RPV with viremia. Median age was 44, 92% male, 30% Latine, 22% Black, 44% unstably housed, and 35% using stimulants. Median number of injections at discontinuation was 5 (min 1, max 20), with 82% on q4 week dosing. Discontinuation occurred after the first injection for 7 (14%) and for 11 (22%) after ≥10 injections. All were prescribed alternate antiretroviral therapy (ART). Median time from discontinuation to database closure was 379 days (IQR 277, 642). Of the 33 PWH initiating LA-CAB/RPV with VS, the most common reason for discontinuation was injection site pain, with or without another side effect/concern (Table). All 28/28 with VL measured after discontinuation had continuous VS while 5 had no VL measurement (2 LTFU, 1 relocation, 1 incarcerated, 1 adherent per provider). Of the 17 PWH initiating with viremia, reasons for discontinuation were pain (n=5), virologic failure (n=4), LTFU (n=3), lateness leading to provider discontinuation (n=2), declined ART (n=1), injection site abscesses (n=1), and relocation (n=1). Of 15 with measured VL after discontinuation, only 3 had continuous VS, however, at last observation, 11 had VS and 4 had viremia off ART (including 1 who died). NNRTI and/or INSTI resistance mutations developed in 3/16 while on injections, 3/16 with missed/late injections, and 1 with VS for 3 months after discontinuation who subsequently discontinued alternate ART. Conclusions: Overall, discontinuation was low, and injection site pain was the most common reason. For PWH initiating LA-CAB/RPV with viremia, VF and missed/late injections accounted for over half of discontinuations, although most ultimately attained VS.

Methods: In a cross-sectional survey of PWH with ≥3 injections at Ward 86 (San Francisco), Grady Ponce de Leon (Atlanta), and the University of Chicago, we assessed treatment satisfaction (HIVTSQ), burden compared to oral ART, and interest in alternate delivery locations and modalities. We summarized responses overall and stratified by viral load (VL) < vs. ≥50 copies/mL at LA-CAB/RPV initiation, using chi-square tests to assess for differences by viremic status. Multivariable logistic regression investigated characteristics of PWH who experienced reduction in effort to remember to take LA-CAB/RPV vs. oral ART (reduction from somewhat/very/extremely difficult to not/a little bit difficult). Results: From 9/2023–7/2024, we surveyed 206 PWH (30% initiating with viremia) with median age 46, 23% cis/trans women, 47% Black, 21% Latine, 36% with housing instability, and 22% with substance use. Median number of injections was 9 (IQR 5,14). Mean (SD) satisfaction using LA-CAB/RPV was 61.5/66 (5.3), and 74% reported mental well-being as better with LA-CAB/RPV. Worry about inadvertent HIV disclosure on oral ART existed for 66% compared to 13% with LA-CAB/RPV. While 35% found remembering both treatment modalities low effort, 62% experienced a substantial reduction in effort with LA-CAB/RPV. In adjusted analyses, unstable housing (AOR = 2.33, 95% CI 1.18, 4.60) and substance use (AOR = 2.42, 95% CI 1.13, 5.19) were associated with reduced effort. Among all PWH surveyed, only 4% found clinic visits more of a problem with LA-CAB/RPV. Preferences for injection location (not mutually exclusive) were their HIV clinic (91%), place where they sleep (32%), community pharmacy (19%), mobile clinic (15%), and community organization (12%). A majority (63%) were at least moderately interested in self-injection and 55% at least moderately interested in injection from someone in their personal life. About half (47%) would prefer another LA modality, e.g. oral, patch. Results were similar stratified by VL at initiation. Conclusions: In a diverse sample of early LA-CAB/RPV adopters, satisfaction was high and treatment burden reduced compared to oral ART, particularly among PWH with unstable housing or substance use. The HIV clinic was the preferred location. However, ~50% would opt for a different LA modality. Outcomes in Those Who Discontinued Injectable Cabotegravir/ Rilpivirine and Resumed Oral ART Tali Faggiano 1 , Jeffrey Yin 2 , Nimish Patel 1 , Afsana Karim 2 , Laura Bamford 2 , Lucas Hill 2 1 University of California San Diego, La Jolla, CA, USA, 2 University of California San Diego Medical Center, La Jolla, CA, USA Background: Real world data continues to accumulate regarding the efficacy of long acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV); however, limited data exists regarding virologic outcomes in those returning to oral therapy after discontinuing LAI CAB/RPV. Methods: Single-center cohort study at the UC San Diego Owen Clinic in those who initiated LAI CAB/RPV but discontinued treatment between 4/2021 and 3/2024. Included were those that received at least 1 injection, with discontinuation prior to 3/2024 to allow for at least 24 weeks of follow up. Excluded were those on LAI CAB/RPV who transferred care out of the clinic as it was often unknown if LAI CAB/RPV was continued. Baseline characteristics and reasons for discontinuation, pre- and post-switch oral antiretroviral (ART) regimens, and virologic outcomes after discontinuation of LAI CAB/RPV were collected. Viral load (VL) time points after discontinuation included the most recent in the range of 1-24 weeks, 24-48 weeks, and the most recent documented viral load through 9/2024. Results: A total of 92 patients were included who discontinued LAI CAB/RPV during the study period. The median age (IQR) was 38 (34-50), 52.2% were non-White race, 37% were Hispanic, 20.7% were female sex assigned at birth, and 33% had active substance use. The majority (78.2%) were on an integrase inhibitor (INSTI) based regimen pre-switch and 90.2% had an HIV VL<50 copies/mL (cpm) prior to starting LAI CAB/RPV with a median CD4 count of 706 cells/mm 3 . The median (IQR) number of CAB/RPV injections received before discontinuation was 4 (2-6) and the median (IQR) time on LAI CAB/RPV was 164 (59-305) days. Table 1 includes the reasons for discontinuing LAI CAB/RPV. The majority of patients (76.6%) switched to an INSTI based regimen after stopping LAI CAB/RPV, with 75.3% returning to the same pre-switch regimen, and 80.4% had a last VL<50cpm at the time of stopping LAI CAB/RPV (9 patients had no VL data on LAI CAB/RPV). A total of 58 patients had VL data available at 24 weeks, 53 at 48 weeks, and 74 with at least one VL after discontinuation (median time to last VL 342 days). The percentage of those with HIV VL <50cpm and <200cpm

Poster Abstracts

685

684

What Do Early Adopters of Long-Acting Injectable Cabotegravir/ Rilpivirine Think About It? Katerina Christopoulos 1 , Moira McNulty 2 , Lauren F. Collins 3 , Matt Hickey 1 , Mallory O. Johnson 1 , Aaloke Mody 4 , Kimberly Koester 1 , Geoffroy Liegeon 5 , Jorge Salazar 1 , Samantha Dilworth 1 , Sophie Plotkin 2 , Kaylin Dance 3 , Xavier Erguera 1 , Elizabeth (Liz) Montgomery 3 , Jonathan Colasanti, for the MODERN ART Study Team 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Chicago Medical Center, Chicago, IL, USA, 3 Emory University, Atlanta, GA, USA, 4 Washington University in St Louis, St Louis, MO, USA, 5 Université Paris Cité, Paris, France Background: Little is known about experiences with long-acting injectable cabotegravir/rilpivirine (LA-CAB/RPV) in underserved people with HIV (PWH), particularly PWH initiating with viremia due to adherence challenges.

CROI 2025 194