Determinants of long-acting cabotegravir plus rilpivirine discontinuation in real-world HIV care: insights from the relativity cohort

Objectives: To evaluate real-world persistence with long-acting cabotegravir plus rilpivirine (CAB+RPV LA) in a nationwide cohort of virologically suppressed adults, describe the main clinical and structural reasons for discontinuation, and identify predictors of early interruption in routine practi...

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Detalles Bibliográficos
Autores: Troya, Jesús, Montes, María Luisa, Galindo, María José, Sánchez-López, María Belén, Pelazas-González, Ricardo, Torralba, Miguel, Santiago, Alberto Díaz De, Fanjul, Francisco, Rodriguez Rodriguez, Adrian, Cabello, Alfonso, Crusells-Canales, María José, Navarro, María del Carmen, Aguilera, María, Hidalgo, Carmen, Morano, Luis Enrique, Vinuesa-García, David, David, Carlos De Andrés, Bernal, Enrique, Martínez-Álvarez, Rosa María, Romero, Alberto, Tiraboschi, Juan, Gimeno-García, Alejandra, Ferreira, Eva María, Losa-García, Juan Emilio, Pedrero-Tomé, Roberto, Buzón-Martín, Luis
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:dnet:docusalut___::e6d7767f871a9064407e57c25a3c854d
Acceso en línea:https://hdl.handle.net/20.500.13003/27525
Access Level:acceso abierto
Palabra clave:HIV
cabotegravir plus rilpivirine
discontinuation
long-acting injectable
real-world study
virological suppression
Descripción
Sumario:Objectives: To evaluate real-world persistence with long-acting cabotegravir plus rilpivirine (CAB+RPV LA) in a nationwide cohort of virologically suppressed adults, describe the main clinical and structural reasons for discontinuation, and identify predictors of early interruption in routine practice. Design: Ambispective, multicenter cohort study assessing the durability, safety, adherence, and virological outcomes of CAB+RPV LA implementation across 58 Spanish healthcare settings. Methods: Adults initiating CAB+RPV LA therapy were enrolled using standardized electronic tools. Baseline demographics, comorbidities, HIV and virological variables, and injection timing were recorded. Permanent discontinuations were attributed to systemic adverse events, injection-site reactions, virological failure (VF), or nonclinical causes. Virological endpoints followed the CONSENSUS-LAI criteria. Kaplan–Meier curves and multivariate Cox models were used to identify the independent predictors. Results: Among 3146 virologically suppressed participants, 199 (6.3%) permanently discontinued therapy over a median 13.8-month follow-up. Discontinuation was more frequent among women (21.6 vs. 14.4%; P = 0.007), foreign-born individuals (42.9 vs. 29.5%; P  < 0.001), those with a higher BMI, and those with shorter prior suppression periods. injection-site reaction- and systemic adverse event-related discontinuations were rare (1.2 and 0.7%, respectively), whereas structural reasons accounted for 3.5%. VF occurred in 20 participants (0.6%). Adjusted analyses showed that age ≥70 years [hazard ratio (HR) 5.41; 95% confidence interval (CI) 1.91–15.32] and foreign nationality (HR 2.06; 95% CI 1.48–2.86) independently increased discontinuation risk, whereas male sex (HR 0.65; 95% CI 0.44–0.96) and longer suppression (HR/day 0.99; P  = 0.036) were protective. Conclusions: In this large national cohort, CAB+RPV LA demonstrated strong persistence, excellent tolerability, and very low rates of VF. Discontinuations were mainly structural, highlighting the need to reinforce continuity-of-care pathways and system-level support for optimal CAB+RPV LA scale-up.

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