Real-world data presented at IDWeek 2026 support the long-term effectiveness of long-acting injectable antiretroviral therapy (ART) for HIV. In a cohort of 7,995 adults who switched from oral ART to injectable cabotegravir/rilpivirine, 94% of those who received at least two injections achieved undetectable viral loads at their last test, and 81% remained undetectable at every test. Confirmed virologic failure—defined as two consecutive viral loads at or above 200 copies/mL or one such result followed by discontinuation—was rare, occurring in just 1% of patients.
The findings come from the OPERA database, which covers about 14% of U.S. HIV patients. Study author Dr. Ricky Hsu noted that the results mirror randomized clinical trials and could increase provider confidence in long-acting injectables. Despite being available for over five years and approved since 2021, these injectables account for only about 5% of HIV prescriptions in the U.S., a gap the researchers attribute partly to lingering doubts among providers.
Among patients who stopped the injections, provider surveys showed the most common reasons were nonadherence to injection visits, loss to care, and a desire to return to oral ART. Injection-site reactions and poor efficacy were rarely cited; instead, logistical hurdles such as insurance coverage and follow-up difficulties drove discontinuations. The study also noted that 77% of those who completed their first two injections remained on the therapy at study end, with a median treatment duration of 18 months. The authors say these real-world data strengthen the case for expanding long-acting injectable ART to populations who struggle with daily oral medication.