Long-acting cabotegravir/rilpivirine, lenacapavir, and ibalizumab use among persons with HIV-1 viremia at a Ryan White-funded clinic in the urban U.S. South

Background People with HIV (PWH) with viremia despite oral antiretroviral therapy (ART) can achieve viral suppression (VS) using long-acting (LA)-ART. Scaling this approach has lagged, especially in highest HIV burden areas. Methods We performed a retrospective review of PWH who initiated LA-ART (cabotegravir/rilpivirine [CAB/RPV] ± lenacapavir [LEN] ± ibalizumab [IBA]) with viremia (≥50 c/mL) at a Ryan White-funded program in the urban South between 4/14/2021–8/31/2024. Among PWH who received ≥3 LA-CAB/RPV injections through end of follow-up (12/31/2024), achieving VS (<50 c/mL) was assessed. Results 81 PWH with viremia initiated LA-ART. 93% identified as Black, 40% were cis/trans-women, median (Q1-Q3) age was 38 (30-49) years and income $25K/yr ($20-33K/yr). Median (Q1-Q3) years since HIV diagnosis was 15.5 (8.8-20.5) and 46% had prior opportunistic conditions. At LA-ART initiation (56 CAB/RPV; 22 CAB±RPV+LEN; 3 CAB±RPV+LEN+IBA), median (Q1-Q3) viral load was 4.0 (2.9-4.8) log10 and CD4+ 186 (62-420) cells/μL. Of 79 PWH who remained engaged, 73 (92%) achieved VS after a median (Q1-Q3) of one (1-2) injection, with CD4 rise to 353 (187-501) cells/μL. Otherwise, two had virologic failure with drug resistance; four had persistent viremia without resistance (>200 c/mL [n=2]; 50-200 c/mL [n=2]). Of 645 LA-CAB/RPV injections (500 Q4wk; 145 Q8wk), 635 (98%) were administered on-time; all LEN (43/43) and IBA (37/37) administrations occurred on-time. Conclusions In the largest Southern US cohort of PWH with viremia initiating LA-ART, 92% achieved VS despite significant barriers to care and disease burden, underscoring LA-ART as a tool to help achieve Ending the HIV Epidemic goals.