Infectious Disease · 2 h ago
Dat’AIDS cohort identifies virologic failure risks with long-acting cabotegravir plus rilpivirine
A French multicenter observational study of 2,196 adults switching to long-acting cabotegravir plus rilpivirine found virologic failure in 1.9% over a median 13 months. Higher BMI, low nadir CD4 count and shorter prior viral suppression were associated with failure; resistance emerged in half of genotyped failure cases.
- Virologic failure occurred in 1.9% over median 13-month follow-up.
- Resistance emerged in 13 of 26 genotyped failure cases.
- Higher BMI, low nadir CD4 and shorter suppression predicted failure.
- Resistance more often compromised dolutegravir/bictegravir susceptibility than doravirine susceptibility.
A multicenter observational study in the French Dat’AIDS cohort assessed virologic failure and subsequent treatment options in 2,196 virologically suppressed adults with HIV-1 who switched to long-acting cabotegravir plus rilpivirine between December 2021 and December 2023. Failure was defined as two consecutive HIV-1 RNA measurements >50 copies/mL or one >200 copies/mL. Remaining drug susceptibility was interpreted using ANRS and Stanford algorithms.
Over a median 13 months of follow-up, 42 participants (1.9%) experienced failure, at a median 103 days. Among 26 failure cases with genotyping, resistance emerged in 13 (50%). Reported susceptibility was maintained more often for doravirine (ANRS 92%; Stanford 96%) than for dolutegravir/bictegravir (58%; 65%). Seven of the 13 resistance cases occurred during low-level viremia or transient rebound followed by re-suppression.
Independent associations with failure included higher BMI (adjusted hazard ratio 1.07; 95% CI 1.01–1.14), nadir CD4 count <200 cells/mm³ (2.44; 1.31–4.56), and prior suppression lasting <12 months (2.39; 1.01–5.19). Historical cabotegravir or rilpivirine resistance-associated mutations also increased risk. The authors support individualized candidate selection and early resistance testing, including during low-level viremia. Interpretation is limited by the observational design, incomplete genotyping of failure cases and availability of only the abstract; algorithm-predicted susceptibility does not establish subsequent treatment efficacy.
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Clinical Infectious Diseases: Risk Factors and Therapeutic Consequences of Virologic Failure With Long-Acting Cabotegravir Plus Rilpivirine in the Dat’AIDS Cohort ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.