P-358. Long-Acting Cabotegravir and Rilpivirine in People Living with HIV and Obesity: Real-World Insights from the RELATIVITY Cohort

Abstract Background Long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) is a well-established regimen for people living with HIV (PLWH), offering high efficacy and tolerability. However, data are limited for individuals with a body mass index (BMI) > 30 kg/m², which may represent a potential risk factor for virological failure. Survival curves for virological failure by baseline BMI category in patients on LAI CAB+RPV. Methods We conducted a multicenter, retro-prospective study (RELATIVITY cohort in Spain) of virologically suppressed PLWH switching to LAI CAB+RPV, with a BMI > 30. We described this population and evaluated factors associated with virological outcomes using Kaplan–Meier analysis. Results A total of 3,203 patients were included in the study: 37 (1.2%) were underweight, 879 (27.5%) had normal weight, 807 (25.2%) were overweight, and 279 (8.7%) were obese (BMI >30). The obese group was significantly older (47 vs. 44 years; p < 0.001) and had a higher proportion of women compared to the normal-weight group (22.3% vs. 14.5%; p < 0.001). Foreign nationality was also more frequent among obese individuals (33.6% vs. 27%; p = 0.028). Comorbidities increased significantly with higher BMI: hypertension (8.3% to 21.5%), diabetes (3.8% to 10.4%), dyslipidemia (17.6% to 36.2%), and non-alcoholic fatty liver disease (1.4% to 6.1%) (p < 0.001 for all comparisons). The most frequent reasons for switching were treatment simplification (25.4%) and improvement in quality of life (55.6%). Standard needles were used in 68.7% of individuals with a BMI >30. Kaplan–Meier analysis revealed no statistically significant differences in time to virological failure across BMI groups, although individuals with obesity showed a non-significant trend toward higher failure rates after 12 months. Cox regression analysis also confirmed the absence of an association. Four individuals (1.4%) in the obese group experienced virological failure, with emergent resistance mutations detected in only one case (L100I, K103N, L74M, T97A, G140S, Q148K, Q148R, E157Q). Discontinuation rates were similar across groups, including those related to local (1.8%) and systemic (1.1%) adverse events. Conclusion In real-world settings, LAI CAB+RPV appears to be a viable option for individuals with a BMI > 30 kg/m², demonstrating efficacy and safety rates comparable to those observed in other real-world cohorts. Disclosures All Authors: No reported disclosures