Long-acting cabotegravir plus rilpivirine in people with HIV aged ≥ 60 years: persistence, virological outcomes, and comorbidity burden in the spanish RELATIVITY Cohort

Evidence on long-acting cabotegravir plus rilpivirine (CAB + RPV LA) in older people with HIV (PWH) remains limited. We evaluated virological outcomes, treatment persistence and injection-schedule adherence by age. This nationwide ambispective RELATIVITY cohort analysis compared virologically suppressed adults aged ≥ 60 and < 60 years who initiated CAB + RPV LA by 31 December 2024. Persistence was assessed using Kaplan–Meier estimates and multivariable Cox regression, including an exploratory age-by-comorbidity interaction. Among 3,349 participants at 53 centers, 407 (12.2%) were aged ≥ 60 years (median, 63.0; interquartile range, 61.0–66.8); 349 were aged 60–69, 54 aged 70–79 and four aged ≥ 80. Older participants had more comorbidities (median, 2 vs. 0), longer prior antiretroviral exposure (18 vs. 9 years) and median follow-up of 26.5 versus 25.1 months. Observed virological suppression was 97.3% versus 96.5%, virological failure 0.2% versus 0.9%, and definitive discontinuation 11.3% versus 11.0%. Age ≥ 60 was not clearly associated with discontinuation after adjustment (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.63–1.36). The exploratory age-by-comorbidity interaction HR was 1.34 (1.07–1.67); the older-group HR per comorbidity was 1.20 (0.99–1.46). Injection-schedule adherence ≥ 90% was observed in 99.5% versus 99.3%. CAB + RPV LA showed high observed virological suppression, persistence and injection-schedule adherence in selected PWH aged ≥ 60 years. Age ≥ 60 showed no clear independent association with definitive discontinuation. Comorbidity burden may inform closer follow-up, although this exploratory finding requires confirmation. Evidence remains limited in those aged ≥ 70 years. ClinicalTrials.gov, NCT07703748.