In a study following nearly 8,000 adults with HIV, most people who began long-acting cabotegravir plus rilpivirine stayed on treatment and kept the virus at very low levels. The findings, presented in Washington, D.C., add evidence from everyday medical care to earlier clinical trials of the injectable therapy.
HIV treatment usually relies on regular antiretroviral medicines, which stop the virus from multiplying. Cabotegravir and rilpivirine, used together, can be given as long-acting injections instead. For adults whose HIV is already suppressed, switching to injections may offer another way to continue treatment. But outcomes in ordinary care can be shaped by practical issues, such as making it to clinic visits, not just by how well a medicine works in a trial.
Ricky Hsu, M.D., of the AIDS Healthcare Foundation in Los Angeles, and colleagues studied real-world treatment records for adults who switched to the injectable combination between Jan. 21, 2021, and Dec. 31, 2025. The researchers followed outcomes through Feb. 28, 2026. Of the 7,995 people who switched, 87% already had suppressed HIV when they started the injections.
The team defined complete initiation as receiving the first two injections no more than 67 days apart. Among the 6,362 people who met that definition, 77% were still receiving care and taking cabotegravir plus rilpivirine at the end of the study. Their median time on the treatment was 18 months. A final viral-load test during their first uninterrupted stretch on the injections showed fewer than 50 copies of the virus per milliliter of blood for 94% of participants. Across all their viral-load tests, 81% stayed below that threshold. Confirmed virologic failure, meaning the treatment did not keep the virus suppressed, was reported in 1%.
The study also looked at why some people stopped. In 182 provider-confirmed cases with survey responses, the leading reasons were missed injection visits, reported in 29%; loss to care, 23%; and a preference to return to pills, 15%. These figures point to a key part of long-acting treatment: injections can reduce the need for daily pills, but they still depend on people being able to attend scheduled appointments and remain connected to care.
Hsu said the findings add evidence that reflects the access challenges patients face in everyday life, and support results from randomized clinical trials showing the combination can be an effective option. The data do not mean injections suit everyone, and the study’s measures describe this group of adults who switched while receiving care. Still, the large real-world cohort offers a clearer picture of both the therapy’s promise and the support people may need to stay on it. As clinics consider long-acting HIV treatment, keeping appointments accessible and helping patients stay connected to care will remain part of making the option work.