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The New Era of Long-Acting Antiretroviral Therapy: When and Why to Make the Switch

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Abstract

Purpose of Review

Despite the availability of safe and effective oral combination antiretroviral therapy, barriers to maintaining viral suppression remain a challenge to ending the HIV epidemic. Long-acting injectable antiretroviral therapy was developed as an alternative to daily oral therapy. This review summarizes the current literature on the efficacy of long-acting cabotegravir plus rilpivirine for the treatment of HIV-1, reasons to switch to injectable therapy, and barriers to switching.

Recent Findings

Long-acting cabotegravir plus rilpivirine is safe and effective in maintaining HIV-1 virologic suppression. Ideal candidates for switching to long-acting cabotegravir plus rilpivirine are virologically suppressed on oral regimens with good adherence and no history of virologic failure or baseline resistance. Indications to switch to injectable therapy include patient preference, the potential for improved adherence, and avoidance of adverse effects. Implementation research is needed to assess and overcome system barriers.

Summary

Long-acting cabotegravir plus rilpivirine is a novel alternative to oral antiretrovirals, with the potential to improve adherence and quality of life in people with HIV.

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Authors and Affiliations

  1. Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA

    Melanie C. Goebel, Thomas P. Giordano & Shital M. Patel

  2. Section of Infectious Diseases, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA

    Emmanuel Guajardo

  3. Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA

    Emmanuel Guajardo

  4. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center Houston, TX, USA

    Thomas P. Giordano

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Goebel, M.C., Guajardo, E., Giordano, T.P. et al. The New Era of Long-Acting Antiretroviral Therapy: When and Why to Make the Switch. Curr HIV/AIDS Rep 20, 271–285 (2023). https://doi.org/10.1007/s11904-023-00665-x

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