Clinical Scorecard: Viral Suppression in People With HIV Receiving Long-Acting Lenacapavir or Cabotegravir
At a Glance
Category
Detail
Condition
HIV treated with long-acting lenacapavir (LEN) and cabotegravir (CAB)
Key Mechanisms
LEN is a first-in-class HIV capsid inhibitor that targets multiple stages of the viral cycle; CAB is an integrase strand transfer inhibitor.
Target Population
Treatment-experienced people with HIV, including people with baseline viremia, resistance, or previous adherence challenges.
Care Setting
Retrospective case series at the Ward 86 HIV Clinic, a Ryan White Program–funded clinic with multidisciplinary implementation support.
Key Highlights
The retrospective case series included 46 patients who initiated long-acting LEN/CAB between March 2023 and May 2025.
At LEN initiation, 22 patients (47.8%) had viral suppression (VS), defined as HIV RNA below 200 copies/mL; 24 (52.2%) were viremic.
Baseline VS was maintained, and all patients without baseline VS attained VS by week 13.
Over a median follow-up of 100 weeks, VS was achieved and sustained in all patients; no consecutive viral loads exceeded 200 copies/mL.
The authors note limitations including retrospective design, sample size, and single-center setting.
Guideline-Based Recommendations
Diagnosis
The study defined VS as HIV RNA below 200 copies/mL and baseline viremia as HIV RNA of 200 copies/mL or greater.
Management
The case series evaluated long-acting LEN/CAB in treatment-experienced patients, including those with viremia, resistance, or adherence challenges.
The article states that CAB/RPV is the only long-acting combination regimen currently approved for combination treatment; LEN/CAB use in this study was not described as an approved regimen.
Monitoring & Follow-up
The study assessed viral-load outcomes through the most recent measurement, with follow-up extended to November 2025.
Risks
The authors identify RPV’s low genetic barrier to resistance as a limitation of CAB/RPV and report baseline NNRTI resistance in 33 of 46 patients (71.7%).
The authors caution that the single-center Ryan White clinic setting and its infrastructure may limit generalizability.
Patient & Prescribing Data
Forty-six treatment-experienced patients initiated long-acting LEN/CAB; mean age was 47.1 years. At initiation, 24 (52.2%) were viremic, and 33 (71.7%) had NNRTI resistance.
All patients without baseline VS attained VS by week 13, and baseline VS was maintained. Suppression remained sustained over a median follow-up of 100 weeks.
Clinical Best Practices
Interpret these findings in the context of a retrospective, single-center case series rather than a comparative trial.
The study used clinician-reviewed electronic medical record data and defined VS as HIV RNA below 200 copies/mL.
Consider the authors’ stated generalizability limitation: the cohort was treated in a Ryan White–funded clinic with available implementation infrastructure.
by Nathanael L. Gistand, Ishaan C. Mishra, Kyle Hunter, Megan J. Heise, Chesa Cox, Janet Grochowski, Francis Mayorga-Munoz, Jon Oskarsson, Mary Shiels, Matthew A. Spinelli, Monica Gandhi
