An analysis of the U.S. OPERA cohort presented by Dr. Ricky Hsu at IDWeek in October 2026 shows that long-acting injectable cabotegravir and rilpivirine maintains real-world HIV viral suppression. Among 7,995 patients, 94% achieved undetectable viral loads, with confirmed failure occurring in only 1% of cases. Despite accounting for just 5% of HIV prescriptions, discontinuations were primarily driven by nonadherence to injection visits and logistical barriers rather than side effects.
Virologic suppression in the OPERA study
- ▪In the OPERA cohort study presented at IDWeek in October 2026, 94% of patients receiving long-acting cabotegravir and rilpivirine had viral loads below 50 copies/mL at their last test, while 81% maintained viral suppression across all tests.
- ▪Only 1% of patients in the OPERA cohort study experienced confirmed virologic failure after switching to long-acting cabotegravir and rilpivirine.
- ▪An OPERA cohort study of 7,995 HIV-positive adults presented by Dr. Ricky Hsu at IDWeek in October 2026 demonstrated that long-acting cabotegravir and rilpivirine maintained virologic suppression.
Injectable therapy persistence and suppression
- ▪Among 6,362 complete initiators of long-acting cabotegravir and rilpivirine in the OPERA study, 77% remained on injectable therapy at study end with a median duration of 18 months.
- ▪Approximately 87% of patients who switched to long-acting cabotegravir and rilpivirine in the OPERA study were virologically suppressed at initiation.
Reasons for treatment discontinuation
- ▪Discontinuations of long-acting cabotegravir and rilpivirine in the OPERA study were infrequently caused by injection-site reactions or lack of efficacy, resulting more often from logistical and insurance challenges.
- ▪In a provider survey of 182 OPERA cohort long-acting cabotegravir and rilpivirine discontinuations, nonadherence to injection visits accounted for 29%, loss to care 23%, and desire to switch to oral therapy 15%.
OPERA database and study design
- ▪The OPERA cohort database captures longitudinal healthcare information for approximately 14% of people living with HIV across the United States.
- ▪The OPERA study observed HIV-positive adults switching to long-acting cabotegravir and rilpivirine between January 2021 and December 2025 through February 28, 2026.
FDA approval and dosing
- ▪The FDA approved long-acting cabotegravir and rilpivirine in 2021 as a complete injectable antiretroviral therapy alternative to daily oral HIV treatment.
- ▪The FDA initially approved long-acting cabotegravir and rilpivirine as a monthly injection before expanding its approval for administration every two months.
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