Clinical outcomes of long‐acting cabotegravir and rilpivirine in people with HIV aged 60 and older: Real‐world data from the Spanish RELATIVITY cohort

Background Long‐acting injectable cabotegravir and rilpivirine (LAI CAB + RPV) is an established maintenance strategy for people with HIV who are virologically suppressed, providing high efficacy and convenience in treatment. However, evidence in older adults (≥60 years), a growing and complex population, is limited. Methods We conducted an ambispective real‐world sub‐analysis of the Spanish RELATIVITY cohort, including people with HIV aged ≥60 years who initiated LAI CAB + RPV across 58 centres. Outcomes (virological suppression, safety, discontinuation and adherence) were compared with those <60 years of age using Kaplan–Meier and Cox models. Results Among the 3146 participants, 370 (11.8%) were aged ≥60 years (median age 63.0 [61.0, 67.0]; 78.3% male). Older adults had longer ART exposure (median 18.0 [11.0, 25.0] years), more comorbidities (79.5%) and lower historical CD4 nadirs than younger adults. After 15 months of follow‐up, the rates of virological suppression remained high and comparable between the groups (97.3% in those aged ≥60 years vs. 96.8% in those <60 years), with very low protocol‐defined virological failure rates (0.3% vs. 0.7%). Discontinuations (7.8% vs. 6.1%) and adverse events (1.6% vs. 0.8%) were infrequent and showed no significant differences between age groups. Adherence to injection visits was excellent, with >89% of the participants aged ≥60 years demonstrating perfect adherence. Conclusion In this large multicentre real‐world sub‐study, LAI CAB + RPV maintained virological control and showed good tolerability in older people with HIV despite high multi‐morbidity and long‐term ART exposure. These findings extend the evidence from previous trials and support LAI CAB + RPV as a feasible option for geriatric HIV care. Longer follow‐up will provide further insights into durability and quality‐of‐life benefits.