Assess viral suppression outcomes after initiation of long-acting lenacapavir (LEN) with cabotegravir (CAB) among treatment-experienced patients with prior adherence challenges and resistance.
Approach:
Design and setting: Retrospective, single-center case series at the Ward 86 HIV Clinic; patients initiated long-acting LEN/CAB from March 2023 through May 2025, with follow-up through November 2025.
Participants and outcomes: The analysis included 46 patients. Viral suppression was defined as HIV RNA below 200 copies/mL; time to suppression was estimated for patients with baseline viremia.
Key Findings:
At LEN initiation, 22 of 46 patients (47.8%) had viral suppression and 24 (52.2%) had viremia.
All patients with baseline suppression maintained it, and all patients with baseline viremia achieved suppression by week 13.
Suppression was sustained over a median follow-up of 100 weeks; no patient had consecutive viral loads above 200 copies/mL.
Baseline NNRTI resistance was reported in 33 patients (71.7%).
Interpretation:
The authors report high and sustained viral suppression in this treatment-experienced cohort, including among patients with baseline viremia.
Limitations:
Retrospective design.
Small sample size and single-center setting.
The clinic’s Ryan White–funded infrastructure and higher reported suppression rates may limit generalizability.
Conclusion:
The authors describe this as the largest case series to date of patients receiving long-acting LEN/CAB and state that it adds to evidence on its use among people with adherence challenges and resistance.
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
