Long-acting cabotegravir and rilpivirine combination shows sustained HIV control in seniors – European AIDS Treatment Group

Report on the Efficacy of Long-Acting Injectable HIV Treatment in Older Adults and its Contribution to Sustainable Development Goal 3

Introduction: Aligning HIV Care with Global Health Targets

In alignment with Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages, this report details a study on a long-acting injectable HIV treatment. The research directly addresses SDG Target 3.3, the commitment to end the epidemic of AIDS by 2030. It evaluates the real-world effectiveness and safety of a long-acting injectable combination of cabotegravir and rilpivirine (CAB plus RPV) in people with HIV, with a specific focus on the aging population. The findings are critical for advancing universal health coverage (SDG Target 3.8) by providing effective and accessible treatment options for individuals aged 60 and older, a demographic with a higher burden of comorbidities.

Methodology

A sub-analysis of the RELATIVITY cohort was conducted to assess the treatment’s real-world performance across 58 healthcare institutions in Spain. The process involved the following steps:

1. Participant Selection: The study included 3,146 individuals with virologically suppressed HIV (HIV-1 RNA
2. Cohort Comparison: Participants were divided into two groups for comparison: 370 individuals aged 60 years or older and 2,775 individuals younger than 60 years.
3. Primary Outcome Measurement: The primary objective was to assess the maintenance of virologic suppression and the rate of virologic failure. Failure was defined as two consecutive HIV-1 RNA values ≥ 200 copies/mL or a single value > 500 copies/mL that resulted in treatment discontinuation.
4. Secondary Outcome Analysis: Secondary outcomes included clinical characteristics, rates of treatment discontinuation, immunologic parameters (CD4+ and CD8+ counts), safety profiles, and adherence to the injection schedule.

Key Findings: Advancing Health Outcomes (SDG 3)

The study’s results demonstrate significant progress toward achieving the health targets outlined in SDG 3, particularly for an aging HIV population.

• High Virologic Suppression: The treatment proved highly effective in maintaining virologic suppression, a cornerstone of ending the AIDS epidemic (SDG Target 3.3). Rates were high and comparable at 15 months, with 97.3% suppression in the older group and 96.8% in the younger group.
• Low Virologic Failure: The rates of virologic failure were exceptionally low and not significantly different between the cohorts (0.3% for the older group vs. 0.7% for the younger group), reinforcing the treatment’s reliability.
• Superior Treatment Adherence: Adherence was significantly higher among participants aged 60 or older (89.3%) compared to the younger group (83.7%). This highlights the long-acting injectable’s potential to improve treatment consistency, a key component of providing quality essential healthcare services under SDG Target 3.8.
• Safety and Immunologic Profile: While participants aged 60 or older had lower baseline CD4+ and CD8+ counts, their immunologic parameters remained stable. Systemic adverse events were slightly more common in the older group (1.6% vs. 0.8%), though the difference was not statistically significant.

Conclusion: Implications for Universal Health Coverage (SDG 3.8)

The RELATIVITY study provides compelling real-world evidence that long-acting injectable CAB plus RPV is an effective and generally well-tolerated treatment for older people with HIV. This is particularly relevant given their common challenges of multimorbidity, polypharmacy, and long histories of antiretroviral therapy. By offering a viable alternative to daily oral medication, this treatment expands access to quality, patient-centered healthcare. This directly supports the principles of SDG 3.8, which advocates for universal access to safe, effective, and quality essential medicines, thereby promoting well-being across all age groups.

Study Limitations

• The ambispective design carried a potential for recall and information bias.
• Reclassification of treatment discontinuation events may have introduced subjectivity.
• The follow-up period of less than 18 months for most participants limits conclusions regarding long-term durability and patient-centered outcomes.

Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article directly addresses this goal by focusing on a medical study for a new HIV treatment (long-acting injectable cabotegravir and rilpivirine). The research aims to improve the health outcomes of people living with HIV by evaluating the effectiveness, safety, and adherence of this treatment. This contributes to the overarching goal of ensuring healthy lives and promoting well-being for all at all ages, particularly for individuals with chronic communicable diseases.

What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

   • The article’s subject is an advanced antiretroviral therapy for HIV. The study’s focus on achieving and maintaining “high virologic suppression” is a cornerstone of the global strategy to end the AIDS epidemic. Effective treatment not only improves the health of individuals but also prevents the further transmission of the virus (Treatment as Prevention), directly contributing to this target.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   • The study provides “compelling real-world evidence” on a long-acting injectable treatment, which represents an advancement in “effective, quality… essential medicines.” By evaluating the safety (“systemic adverse events”) and effectiveness of this new treatment option, the research contributes to the body of knowledge needed to ensure that healthcare services for people with HIV are of high quality.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.3

   • Rate of Virologic Suppression: The article explicitly uses this as a primary outcome. It states that the rates “remained high and comparable between the groups at 15 months — 97.3% among participants aged 60 years or older and 96.8% among those younger.” This is a direct measure of treatment effectiveness, which is essential for ending the AIDS epidemic.
   • Rate of Virologic Failure: This is also a primary outcome, defined as “two consecutive HIV-1 RNA values ≥ 200 copies per mL or a single value > 500 copies per mL.” The article reports low rates of “0.3% and 0.7%, respectively,” indicating the high efficacy of the treatment in controlling the virus.

2. Indicators for Target 3.8

   • Treatment Adherence: The article measures adherence to the injection schedule, noting it was “significantly higher in participants with HIV infection aged 60 years or older than in those younger than 60 years (89.3% vs 83.7%).” Adherence is a key indicator of the successful delivery and patient acceptance of a healthcare service.
   • Rate of Systemic Adverse Events: The safety profile is a crucial component of quality healthcare. The article reports that these events were “more common in the older group (1.6% vs 0.8%),” providing data to assess the safety of this essential medicine.
   • Treatment Discontinuation Rate: The article notes that permanent discontinuation occurred in “7.8%” of the older group and “6.1%” of the younger group. This indicator reflects the overall tolerability and patient experience with the treatment, which are aspects of healthcare quality.

Table of SDGs, Targets, and Indicators

Source: eatg.org