Ninety-six-week observational outcomes of long-acting injectable HIV therapy in people with adherence challenges, including people who use drugs.

OBJECTIVE: To evaluate virological outcomes of people with HIV (PWH) and adherence challenges to oral antiretroviral therapy (ART) who initiate long-acting injectable ART. DESIGN: Observational cohort study. SETTING: Single-center urban HIV primary care clinic at the University of California San Diego. PARTICIPANTS: All PWH who initiated long-acting injectable (LAI)-ART between November 2021 and September 2023 with documented adherence challenges to oral ART. MAIN OUTCOME MEASURES: The primary outcomes were virologic failure (two consecutive viral loads ≥200 copies/ml, one viral load ≥1000 copies/ml, or one viral load ≥200 copies/ml with evidence of resistance mutation to LAI-ART ≥30 days after initiation of LAI-ART) or discontinuation of LAI-ART for any reason within 96 weeks of initiation. RESULTS: Of the 62 eligible individuals, 48 (77.4%) remained virologically suppressed on LAI-ART and 14 (22.6%) discontinued therapy by 96 weeks. Of these 14 individuals, 3 experienced virologic failure (at 28, 40, and 42 weeks) and 3 were lost to follow-up. There were similar outcomes among the 26 participants with active substance use, of whom 18 (69%) remained suppressed on LAI-ART at 96 weeks. The remaining participants discontinued LAI-ART due to preference, adverse events, insurance issues, or death. CONCLUSION: High rates of viral suppression were achieved and maintained at 96 weeks, supporting the use of LAI-ART among those with adherence challenges to oral ART, including those with significant barriers to care, including substance use disorder and psychiatric comorbidities.