Genotyping not required for sustained effectiveness of long-acting cabotegravir plus rilpivirine: evidence from the RELATIVITY cohort
Year: 2025
Type: article
Abstract: OBJECTIVES: Long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) provides an alternative to daily therapy for people with HIV (PWH) with virologic suppression. Although genotypic testing is recommended before switching, its real-world clinical value is unclear. We assessed outcomes after switching to LAI CAB+RPV with or without available genotypes in the Spanish RELATIVITY cohort. DESIGN: RELATIVITY is a multicenter, ambispective cohort study assessing the effectiveness and safety of LAI CAB+RPV in adults with HIV across 58 centers in Spain. METHODS: Posthoc analysis of 3146 participants, focusing on the availability of genotypic resistance data before switching. RESULTS: Of the 3146 participants, 53.5% ( n = 1682) did not have genotypes available. The median follow-up was 13.3 months [interquartile range (IQR) 8.6, 18.9] in the no-genotype group and 14.9 months (IQR 9.0, 19.2) in the genotype group ( P = 0.003). Both groups maintained high virological suppression rates (>93%) up to the 23rd month of follow-up, with no significant differences observed in virological or immunological outcomes. Virologic failure rates (0.5% vs. 1.0%; P = 0.476) and permanent discontinuation rates (6.1% vs. 6.6%; P = 0.804) were similar. Of the 20 participants with virologic failure, 12 had genotype data. After resuming oral antiretroviral therapy, 8 of those with and 4 of those without the genotype achieved undetectable viral loads. Adherence to injection schedules and changes in body mass index were comparable. CONCLUSIONS: In this large real-world cohort, the absence of genotypic data did not affect LAI CAB+RPV effectiveness in virologically suppressed PWH. Limitations, including ambispective design, short follow-up, and low non-B subtype prevalence, may limit generalizability.
Source: AIDS
Authors: Luis Buzón-Martín, José I. Bernardino, María José Galindo Puerto, Juan Martín-Torres, María Remedios Alemán Valls, Miguel Torralba González de Suso, Alberto Díaz de Santiago, Francisco Fanjul, Adrián Rodríguez, Alfonso Cabello Úbeda, Roberto Pedrero-Tomé, María José Crusells Canales, Sonia Calzado Isbert, María Aguilera García, Carmen Hidalgo Tenorio, Luis Morano, David Vinuesa García, Carlos de Andrés David, Enrique Bernal Morell, Rosa María Martínez Álvarez, Noemí Cabello Clotet, Juan Tiraboschi, Alejandra Gimeno García, María Jesús Vivancos, Jesús Troya, the RELATIVITY Cohort Group*
Institutions: Hospital Universitario de Burgos, Hospital Universitario La Paz, Hospital Clínico Universitario de Valencia, Hospital Universitario 12 De Octubre, Hospital Universitario de Canarias, Hospital Universitario de Guadalajara, Hospital Universitario Puerta de Hierro Majadahonda, Hospital Universitario Son Espases, Hospital Son Llatzer, Hospital Universitario Fundación Jiménez Díaz, Hospital Universitario Infanta Leonor, Hospital Clínico Universitario Lozano Blesa, Corporació Sanitària Parc Taulí, Hospital Universitario de La Princesa, Hospital Universitario Virgen de las Nieves, University Hospital Complex Of Vigo, Hospital Reina Sofía de Murcia, Hospital Universitario Miguel Servet, Hospital Clínico San Carlos, Bellvitge University Hospital, Hospital Universitario de Torrejón, Hospital Universitario Ramón y Cajal
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415827415