Long‐acting injectable cabotegravir and rilpivirine in observational cohort studies: A systematic review on virological failure, resistance and re‐suppression outcomes in virally suppressed individuals living with HIV

作者：Kyle Ring, Alexa Elias, Megan Devonald, Melanie Smuk, Chloe Orkin · 发表于：HIV Medicine · 年份：2025 · DOI：10.1111/hiv.70057 · 被引用次数：14 · 研究领域：HIV/AIDS drug development and treatment、HIV-related health complications and treatments、HIV Research and Treatment

INTRODUCTION: Randomized controlled trial evidence suggests that long-acting injectable (LA-I) cabotegravir and rilpivirine (CAB+RPV) has similar virological failure (VF) rates to daily oral therapy, but clinical practice evidence is lacking. Integrase inhibitor (INI) resistance may limit future therapy. The optimal regimen is uncertain. METHODS: We synthesized evidence from PubMed, EMBASE, Cochrane and conference abstract databases through 18 November 2024, to identify observational cohort studies (OCS) that reported on VF events in virally suppressed individuals who switched to LA-I CAB+RPV. We extracted data on VF, resistance-associated mutations (RAMs) at VF, post-VF regimen choice and re-suppression. We assessed the risk of bias using a modified Downs and Black tool. RESULTS: VF definitions differed considerably among OCS, with 172 individuals experiencing VF across 79 cohorts that included 13 899 individuals. Twenty-eight cohorts (n = 7987) reported genotypic information at VF. Out of the 80 VF events with genotypic information available at the time of the VF event, NNRTI mutations were identified in 45 cases, INIs in 40 cases, and dual-class resistance in 33 cases. Notably, 28 VF events were not accompanied by resistance. Post-VF regimen choices were reported for 92 VF events. Regimens used were protease inhibitor (PI)-based, oral INI-based and some physicians continued LA-I CAB+RPV post-VF. Re-suppression occurred in 87.8% (65/74) of VF events in which it was describe...