Long-acting cabotegravir and rilpivirine in people with HIV and obesity: Real-world outcomes from the RELATIVITY cohort

Introduction: Long-acting injectable cabotegravir and rilpivirine (LAI CAB + RPV) is a well-established regimen for people with HIV (PWH) that offers high efficacy and tolerability. However, data are limited for obese individuals with a body mass index (BMI) >= 30 kg/m(2), which may represent a p...

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Autores: Troya, J, Mican, R, Galindo, MJ, Bisbal, O, Romero, L, Torralba, M, Buzón-Martín, L, de la Fuente, S, Fanjul, F, Rodríguez, A, Cabello, A, Sanjoaquin, I, Navarro, MD, Aguilera, M, Hidalgo-Tenorio, C, Morano, LE, Martínez, C, Poquet, I, Bernal, E, Caballero, R, Cabello-Clotet, N, Fernández, A, Montero, MD, Vivancos-Gallego, MJ, Tejerina, F, Soria, G, de Zárraga, MA, Cairó, M, Romero, A, Cabo, R, Arenas, V, Sepúlveda, MA, Alcaraz, A, Escrich, C, González-Rico, C, Ferreira, EM, Valentín, B, Muelas-Fernández, M, Llenas-García, J, García, S, Losa-García, JE, Alonso, B, Sanz, J, Gutiérrez, F, Vázquez, N, Corte, JJ, Garcinuño, MA, Gainzarain, JC, Estébanez, M, Pedrero-Tomé, R, Montes, ML
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20713
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/20713
Access Level:acceso abierto
Palabra clave:body mass index
cabotegravir plus rilpivirine
HIV
long-acting injectable
obesity
real-world study
virologic suppression
Descripción
Sumario:Introduction: Long-acting injectable cabotegravir and rilpivirine (LAI CAB + RPV) is a well-established regimen for people with HIV (PWH) that offers high efficacy and tolerability. However, data are limited for obese individuals with a body mass index (BMI) >= 30 kg/m(2), which may represent a potential risk factor for virologic failure (VF). Methods: We conducted a multicentre, ambispective study (RELATIVITY cohort, Spain) of virologically suppressed PWH with BMI >= 30 kg/m(2) who switched to LAI CAB + RPV. This study characterized this population and evaluated the factors associated with virologic outcomes, tolerability and adherence using Kaplan-Meier analysis. Results: Among the 3,203 individuals recruited in the RELATIVITY cohort, 57 were excluded due to detectable HIV RNA at the time of switching to LAI CAB+RPV, and 3,146 were finally included, all of whom had HIV RNA levels <50 copies/mL at baseline. BMI data were available for 2,736 participants, of whom 362 (11.5%) had a BMI >= 30 kg/m(2) and 2,374 had a BMI <30 kg/m(2). Obese participants were older (median age 48 vs. 45 years) and included a higher proportion of women (21.9% vs. 13.7%). Comorbidities included dyslipidaemia (36.7%), hypertension (22.9%), diabetes (11.6%), chronic lung disease (6.4%), MASLD (5.5%) and coronary disease (3.3%). The main reasons for switching included quality-of-life improvement (49.2%), patient requests (35.4%), and therapy simplification (26%). VF was rare, occurring in 1.1% of obese individuals and 0.6% of non-obese participants over a median follow-up of 13.8 months (p = 0.284). Emergent resistance mutations were detected in 2/4 VF in obese participants. The discontinuation rate was low across all study groups. Among participants with obesity, local adverse events accounted for 1.9% of discontinuations, systemic adverse events for 0.8%, and other causes for 3.9% of discontinuations. In this subgroup, 72.9% of injections were administered using a 38-mm needle. Injection adherence was excellent, with 83.1% of participants with obesity achieving full (100%) coverage and an additional 16.3% maintaining 90-99.9% coverage. Conclusions: In this real-world cohort, LAI CAB + RPV was safe and effective in PWH with obesity, with comparable VF rates, tolerability, and adherence to participants without obesity. These findings support the use of LAI CAB + RPV across diverse PWH populations, including those with a BMI >= 30 kg/m(2), and highlight its feasibility in PWH with multiple comorbidities.

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