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At 48 weeks, 98% of patients with HIV and initial viremia on long-acting ART achieved viral suppression, supporting updated HIV treatment guidelines.

A single-center analysis of long-acting antiretroviral therapy (LA-ART) for patients with HIV found high rates of viral suppression at 48 weeks in both individuals who started LA-ART with and without viremia. Researchers reported their findings in a letter published in JAMA.

“At 48 weeks, 98% (94/96; 95% CI, 93%-99%) of patients with initial viremia had undetectable viral loads, including five who achieved viral suppression with use of LA-ART but returned to oral ART for convenience or adverse events and maintained viral suppression at 48 weeks,” wrote corresponding author Monica Gandhi, MD, MPH, and colleagues.

The study investigated viral suppression rates for 370 patients with HIV who attended the Special Program of Long-Acting Antiretrovirals to Stop HIV initiative at the Ward 86 HIV clinic in San Francisco between January 2021 and September 2024. Among the patients, 129 had viremia (HIV RNA level ≥30 copies/mL) at LA-ART initiation, and 241 did not.

To participate in the program, patients with viremia were required to commit to monthly in-person visits. The authors of the research letter explained that if viral load fell to undetectable levels after 3 months, injections were spaced bimonthly. A pharmacist reviewed each patient’s ART history and resistance, and a pharmacy technician provided patient counseling. Patients received appointment reminders but could drop in for injections within a week of the target date.

For patients with viremia, the median viral load at LA-ART initiation was 45,600 copies/mL, and CD4⁺ counts were less than 200 cells/mm³ in 50%. Patients who started LA-ART with viremia had higher rates of substance use, housing instability, and low CD4⁺ counts.

The study found that rates of viral suppression at 24 weeks were 97% in patients with initial viremia and 99% in patients without initial viremia. At 48 weeks, 98% of patients with initial viremia had achieved viral suppression compared with 99% of patients without initial viremia.

“In 2024, data from the program were cited in modifications to the US Department of Health and Human Services and International Antiviral Society–USA HIV treatment guidelines to recommend LA-ART among people with HIV with viremia and adherence challenges,” the authors wrote. “These comparison data further bolster changes to HIV treatment guidelines.”