Long-Acting Cabotegravir and Rilpivirine in Patients With HIV With Solid Organ Transplantation: A Case Series.

Abstract

Background: Managing individuals with both HIV infection and a history of solid organ transplantation presents unique challenges due to interactions between antiretroviral therapy and immunosuppressive regimens. Long-acting injectable therapies may offer advantages in reducing drug interactions and improving adherence.

Methods: This retrospective study assessed the virological efficacy and safety of long-acting injectable therapy with a combination of 2 antiviral agents in 5 patients with stable HIV infection who had undergone kidney or liver transplantation. Patients were followed for up to 74 weeks after initiating therapy. Virological response, immunological parameters, renal and hepatic function, and immunosuppressive drug levels were monitored.

Results: All patients maintained undetectable viral loads throughout the study period, with no virological failure or drug-resistance development. CD4⁺ T-cell counts remained stable, and no clinically significant changes in renal or hepatic function were observed. Immunosuppressive drug levels remained within the therapeutic range without requiring dose adjustments. No patient experienced severe adverse effects or injection-site complications, and adherence was high throughout the study.

Conclusions: Long-acting injectable therapy was effective and well tolerated in individuals with stable HIV infection following solid organ transplantation. The findings suggest that this approach may be a viable treatment option, reducing drug interactions while maintaining virological suppression. Further research with larger cohorts is needed to confirm these findings and establish guidelines for implementation in transplant recipients.