Long-Acting ART Offers Clinical Gains and Potential Cost Savings for HIV Care

Key Clinical Summary

• In a real-world US study presented at ID Week, people with HIV who switched from daily oral ART to Cabenuva (cabotegravir + rilpivirine long-acting) achieved higher rates of adherence and viral suppression.
• Most participants and providers reported improved quality of life, reduced stigma, and preference for long-acting therapy.
• From a payer perspective, improved adherence may translate into fewer hospitalizations and lower long-term care costs.

At ID Week 2025, ViiV Healthcare presented new real-world evidence demonstrating that Cabenuva (cabotegravir + rilpivirine long-acting, or CAB+RPV LA) significantly improves treatment adherence and viral suppression among people with HIV (PWH) who have struggled to stay consistent on daily oral antiretroviral therapy (ART).¹ These findings add to growing data that long-acting injectables could play an important role not only in patient outcomes but also in long-term cost efficiency from a payer standpoint.

Background: Addressing Persistent Adherence Barriers

Maintaining viral suppression in HIV requires near-perfect adherence to ART. Even small lapses can lead to viral rebound, drug resistance, and higher health care utilization. Despite the advent of potent single-tablet regimens, adherence challenges remain widespread due to factors such as pill fatigue, stigma, forgetfulness, and lifestyle constraints.²

The introduction of long-acting injectable ART regimens like CAB+RPV LA offers an alternative: monthly or every-2-month injections administered in a health care setting. This eliminates daily pill-taking, reduces stigma, and provides regular engagement between patients and providers.

Previous randomized trials such as LATITUDE³ have already shown superior efficacy for CAB+RPV LA among patients with documented adherence difficulties. The data presented at ID Week—drawn from the PREFER-LA real-world observational study—reinforces that success outside of controlled clinical settings.

Study Design: Real-World Outcomes in a Diverse US Population

The PREFER-LA study included 159 adults with HIV-1 across the US who had switched from daily oral ART to CAB+RPV LA and had been on the injectable therapy for 6 to 18 months. All participants had documented adherence challenges prior to switching, as identified by their health care providers.

Adherence challenges were categorized as:

• Situational nonadherence: previously suppressed individuals who experienced viral re-bound.
• Sub-optimal adherence: self-reported inconsistent pill-taking despite maintained control.
• Intermittent adherence: treatment interruptions lasting four weeks or more.
• Non-adherence: documented inability or unwillingness to take oral ART.

Researchers collected data through surveys and medical chart reviews, pairing patients’ perceptions with objective virologic outcomes and provider insights.

Results: Significant Improvements in Adherence and Viral Suppression

At baseline, 89% of participants had a viral load ≤200 copies/mL. After switching to CAB+RPV LA, 98% achieved or maintained viral suppression below this threshold. The proportion of patients with undetectable viral loads (<50 copies/mL) rose from 77% before switching to 88% after.

Health care providers echoed the positive outcomes, reporting improved adherence, better overall health, and more consistent follow-up visits. Nearly all providers (95%) said their patients were likely to remain on CAB+RPV LA long term, citing both clinical stability and lifestyle compatibility.

Participants themselves cited ease of adherence, convenience, reduced stigma, and freedom from daily reminders of their diagnosis as key motivators. Many also reported improved mental well-being and self-perception since switching to the injectable therapy.

Concerns that might have limited uptake—such as fear of needles or injection-site pain—dropped substantially after initiation. The proportion of patients reporting “no concerns” about their regimen more than doubled after 6 months on CAB+RPV LA.

Payer Perspective: Long-Term Value Beyond Viral Suppression

From a managed care perspective, these data raise compelling questions about cost-effectiveness and health system value. While injectable ART has higher upfront drug administration costs,⁴ improved adherence and viral suppression may reduce hospitalizations, opportunistic infections, and the need for resistance testing or salvage therapy, all major cost drivers in HIV care. Long-acting injectables, by mitigating adherence gaps, could help payers achieve savings through reduced downstream costs and improved population-level viral suppression.

In particular, for populations with high rates of social instability or barriers to consistent medication access—such as younger adults, people experiencing homelessness, or those facing stigma—clinic-administered injections offer both clinical oversight and a safeguard against missed doses.

Furthermore, regular clinic visits tied to injection schedules provide opportunities for integrated care interventions, including mental health screening, sexual health counseling, and linkage to social services—each of which can enhance overall health outcomes and reduce system-wide costs.

Limitations and Next Steps

While the PREFER-LA study provides valuable insights, it is not without limitations. As an observational, cross-sectional analysis, it cannot fully account for selection bias—patients who successfully transitioned to long-acting therapy may already be more engaged in care. Additionally, most participants had been on CAB+RPV LA for only about 1 year; longer-term durability of adherence and viral suppression remains under study.

Still, the findings strongly support expanding access to long-acting injectables, particularly for patients with known adherence barriers. For payers, this could mean considering value-based reimbursement models that reward improved adherence and sustained viral control rather than focusing solely on drug cost.

Conclusion: Redefining HIV Care Through Adherence Innovation

The data presented by ViiV Healthcare at ID Week reinforce that long-acting injectable ART like Cabenuva offers more than convenience, it represents a paradigm shift in adherence strategy. By combining viral control with enhanced patient satisfaction and potential long-term cost savings, CAB+RPV LA could reshape payer priorities and clinical practice alike.

As HIV care continues to evolve, the challenge for managed care organizations will be balancing upfront investment in innovative therapies with downstream benefits in health outcomes, cost containment, and patient quality of life. For many, the evidence from studies like PREFER-LA suggests that the scales may already be tipping in favor of long-acting injectables.

Reference

1. Henry Z, Kirk S, Brownlee M, et al. PREFER-LA: People with HIV (PWH) in the United States with prior adherence challenges with oral antiretroviral therapy (ART) prefer cabotegravir + rilpivirine long-acting (CAB+RPV LA) therapy after switch. Presented at: ID Week 2025; October 19-22, 2025; Atlanta, GA.
2. Freeman R, Gwadz M, Francis K, Hoffeld E. Forgetting to take HIV antiretroviral therapy: a qualitative exploration of medication adherence in the third decade of the HIV epidemic in the United States. SAHARA J. 2021 Dec;18(1):113-130. doi:10.1080/17290376.2021.1989021.
3. The LATITUDE Study: Long-Acting Therapy to Improve Treatment SUccess in Daily LifE. ClinicalTrials.gov identifier: NCT03635788. Updated September 2, 2025. Accessed November 4, 2025. https://www.clinicaltrials.gov/study/NCT03635788
4. Nguyen N, Lane B, Golub SA, et al. Long-acting injectable ART to advance health equity: a descriptive analysis of US clinic perspectives on barriers, needed support and programme goals for implementation from applications to the ALAI UP Project. J Int AIDS Soc. 2024 Jul;27 Suppl 1(Suppl 1):e26282. doi:10.1002/jia2.26282.