DELAYING the rollout of long-acting injectable antiretroviral therapy (ART) in people with HIV and persistent viremia in the U.S. may result in thousands of avoidable deaths and years without viral suppression, according to new modeling data. The study evaluated potential outcomes if access to long-acting cabotegravir/rilpivirine (LA-CAB/RPV) were expanded sooner rather than after future trial results.
Researchers used a microsimulation model to assess various implementation strategies for patients with persistent viremia and inconsistent engagement in care, comparing daily oral ART with LA-CAB/RPV, both accompanied by intensive support services (ISS). Four implementation scenarios were considered, including current practice, immediate full or partial adoption, and delayed rollout after future trials.
Under current practice, where only 1% of eligible patients receive LA-CAB/RPV, projections over five years included 35,810 virologically suppressed person-years (VSPY) and 17,640 deaths. In contrast, immediate complete implementation could increase VSPY by 26,830 and avert 3,980 deaths. For each year LA-CAB/RPV access is delayed, an estimated 800 additional deaths and 5,370 fewer VSPY are projected.
Even modest or phased implementation while awaiting additional trial data showed clear benefit. A one-arm trial scenario followed by gradual rollout yielded 1,700 additional VSPY and 330 fewer deaths compared to the status quo. Delaying until after a randomized trial would still produce benefit, but to a lesser degree.
The data suggest that long-acting ART with supportive services has the potential to significantly improve outcomes in this vulnerable population. The study’s authors argue for broader, immediate access to LA-CAB/RPV alongside intensive patient support, even while trial data continue to accumulate.
Reference:
Pei P et al. Clinical consequences of delaying implementation of long-acting antiretroviral therapy for people with HIV and persistent viremia in the US. Clin Infect Dis. 2025. doi:10.1093/cid/ciaf428.
