Cabotegravir Plus Rilpivirine Injection for Virally Suppressed Persons with HIV-1 infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Area of Science:

• Infectious Diseases
• Virology
• Pharmacology

Background:

• Antiretroviral therapy (ART) is crucial for managing HIV-1 infection.
• Long-acting injectable formulations offer an alternative to daily oral ART.
• Cabotegravir/rilpivirine is a long-acting injectable combination ART.

Purpose of the Study:

• To evaluate the efficacy and safety of long-acting cabotegravir/rilpivirine versus oral standard of care.
• To compare viral load suppression rates at 48 and 52 weeks.
• To assess treatment discontinuation and adverse effects between the two formulations.

Main Methods:

• A systematic electronic search (2005-2024) identified relevant randomized controlled trials (RCTs).
• Meta-analysis of five RCTs involving 2215 participants (1390 on long-acting cabotegravir/rilpivirine).
• Efficacy assessed by viral suppression rates; safety by adverse effects and treatment discontinuation using risk ratios and confidence intervals.

Main Results:

• Long-acting cabotegravir/rilpivirine demonstrated comparable efficacy to oral ART in maintaining viral suppression (RR 0.99, 95% CI 0.97-1.01).
• Oral treatment was associated with a higher incidence of adverse effects (RR 1.32, 95% CI 1.12-1.54).
• A significantly increased risk of treatment withdrawal was observed with oral regimens compared to injections.

Conclusions:

• Long-acting cabotegravir/rilpivirine is an effective and safe alternative for long-term HIV-1 maintenance therapy.
• The injectable formulation offers a tolerable safety profile and potentially reduces treatment burden.
• Findings support the use of long-acting injectables for sustained viral load suppression in HIV-1 management.