Brief Report: Real-World Uptake and Clinical Outcomes of Long-Acting Injectable Cabotegravir/Rilpivirine in the United States, 2021–2023

BACKGROUND: Long-acting injectable antiretroviral therapy offers an alternative to daily oral regimens for people with HIV. We assessed national uptake and characteristics of persons prescribed injectable cabotegravir/rilpivirine (CAB/RPV) in the United States from 2021 to 2023. METHODS: We conducted a retrospective cohort study using HealthVerity Marketplace, a national claims database with pharmacy, medical, and laboratory data. People with HIV with ≥1 closed, approved prescription claim for CAB/RPV or oral ART were identified. Demographic, clinical, and payer characteristics, viral load (VL), and CD4 counts were examined. RESULTS: From 2021 to 2023, 4087 individuals were prescribed CAB/RPV (21,698 prescriptions), comprising 1.3% of all ART prescriptions by 2023. CAB/RPV recipients were more likely to be aged 25-44 and enrolled in Medicaid. CAB/RPV prescribing was disproportionately low in the Southern United States and among adults 55 years and older, despite higher HIV prevalence in these groups. Among individuals with a detectable VL at initiation (52.2%), 7.2% had viremia (≥200 copies/mL). Among those with ≥1 follow-up VL (n = 2234), 1.8% experienced confirmed virologic failure, defined as ≥2 VLs ≥200 copies/mL. CD4 counts remained stable, with median values near 700 cells/mm 3 pre- and postinitiation. CONCLUSION: While CAB/RPV uptake is increasing, its use remains modest and uneven. High rates of virologic suppression support its real-world effectiveness, but disparities by age, region, and payer point to persistent barriers. Continued real-world monitoring and targeted implementation strategies are critical to fully realizing the potential of long-acting injectable ART.