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Long-Acting Lenacapavir and Cabotegravir and Viral Suppression Among People With HIV
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Oct 8 2026
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In conclusion, long-acting LEN/CAB was initiated in a cohort of treatment-experienced patients with high rates of NNRTI resistance. High VS was achieved regardless of baseline viremia and sustained over a median time of 100 weeks, with no consecutive viral loads greater than 200 copies/mL. This study represents the largest case series of long-acting LEN/CAB and adds to the growing evidence supporting its use for patients with adherence challenges and resistance.
We previously reported outcomes from a 4-clinic case series of 34 patients where viral suppression doubled when taking long-acting LEN/CAB (47% to 94%), with other small case series showing efficacy.6-8 Here, we evaluated outcomes among patients with prior adherence challenges, treatment experience, and resistance initiating LEN/CAB.1
Results
Overall, 46 participants who initiated long-acting LEN/CAB were included in the analyses (mean [SD] age, 47.1 [11.8] years; 32 men [69.6%], 11 women [23.9%], and 3 gender diverse individuals [6.5%]; 16 Black or African American [34.8%], 16 Hispanic or Latino [34.8%], and 11 White [23.9%] individuals) (Table). Baseline nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance was high (33 patients [71.7%]), while integrase strand transfer inhibitor resistance was low (4 individuals [8.7%]). At LEN initiation, 22 patients (47.8%) were suppressed, 24 (52.2%) were viremic, and 17 (37.0%) had RPV included in the regimen. Among 24 patients with viremia prior to initiating LEN, more than half (14 patients [58.3%]) had a CD4+ count of 200 cells/mm3 or fewer. Patients with baseline VS maintained VS, and all patients without baseline VS achieved VS by 13 weeks. Time to VS estimated among those without baseline VS is shown in the Figure. To assess durability of VS, follow-up was extended to a median (IQR) of 100 (63-131) weeks from first LEN injection to the most recent viral load. All patients achieved and maintained VS, with no consecutive viral load greater than 200 copies/mL.
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