Background: Long-acting injectable antiretroviral therapy (LAI-ART) offers an alternative to daily oral regimens for people with HIV (PWH). We assessed national uptake and characteristics of persons prescribed injectable cabotegravir/rilpivirine (CAB/RPV) in the United States from 2021 to 2023. Methods: We conducted a retrospective cohort study using HealthVerity Marketplace™, a national claims database with pharmacy, medical, and laboratory data. PWH with ≥1 closed, approved prescription claim for CAB/RPV or oral ART were identified. Demographic, clinical, and payer characteristics, viral load (VL), and CD4 counts were examined. Results: From 2021 to 2023, 4,087 individuals were prescribed CAB/RPV (21,698 prescriptions), comprising 1.3% of all ART prescriptions by 2023. CAB/RPV recipients were more likely to be aged 25–44 and enrolled in Medicaid. CAB/RPV prescribing was disproportionately low in the Southern U.S. and among adults ≥55 years, despite higher HIV prevalence in these groups. Among individuals with a detectable VL at initiation (52.2%), 7.2% had viremia (≥200 copies/mL). Among those with ≥1 follow-up VL (n=2,234), 1.8% experienced confirmed virologic failure, defined as ≥2 VLs ≥200 copies/mL. CD4 counts remained stable, with median values near 700 cells/mm 3 pre- and post-initiation. Conclusion: While CAB/RPV uptake is increasing, its use remains modest and uneven. High rates of virologic suppression support its real-world effectiveness, but disparities by age, region, and payer point to persistent barriers. Continued real-world monitoring and targeted implementation strategies are critical to fully realizing the potential of long-acting injectable ART.
O’Shea et al. (Thu,) studied this question.