TOPLINE:

Switching to the long‑acting cabotegravir plus rilpivirine regimen was not associated with significant weight gain, clinically meaningful changes in body composition, or adverse metabolic effects in patients with HIV infection over 48 weeks and maintained virologic suppression.

METHODOLOGY:

• Researchers conducted a prospective cohort study of 29 patients with HIV infection (median age, 51.7 years; 37.9% assigned female sex at birth) to evaluate whether switching to long‑acting cabotegravir plus rilpivirine affects body composition and metabolic health.
• Changes in body composition were assessed using DEXA scans and bioelectrical impedance analysis; anthropometric measurements were recorded, and muscle strength was measured using a handgrip dynamometer.
• Laboratory testing of blood samples included HIV parameters, liver function, lipid profiles, creatinine levels, total testosterone levels, and progesterone and estradiol levels in women.
• Cardiovascular risk and insulin resistance were assessed, and patient-reported outcomes were obtained using standardized questionnaires.
• All assessments were performed at treatment initiation and at weeks 24 and 48.

TAKEAWAY:

• At 48 weeks, body weight and BMI did not change significantly. Waist circumference decreased significantly (P = .026), whereas the trunk-to-limb fat ratio increased modestly (P = .035). Total body fat percentage, visceral adipose tissue, and muscle strength remained unchanged.
• High-density lipoprotein cholesterol levels increased significantly (P = .011), with a parallel increase in total cholesterol levels (P = .041) at 48 weeks. Serum creatinine levels decreased (P < .001), largely among people who had previously received bictegravir- or dolutegravir-based regimens.
• Total testosterone levels declined significantly at 48 weeks (P = .005); however, progesterone or estradiol levels in women did not change significantly.
• Virologic suppression was maintained in all patients, and fasting glucose levels, insulin levels, liver function parameters, cardiovascular risk, and insulin resistance indices remained stable. Adverse events were common after the first injection, but their frequency decreased with subsequent doses.

IN PRACTICE:

“These findings support the use of CAB + RPV LA [long‑acting cabotegravir plus rilpivirine] as an effective and well-tolerated treatment option that does not negatively impact weight or metabolic health in the short term and could be a valuable option for patients needing alternatives to daily oral regimens,” the authors wrote.

SOURCE:

The study was led by Andrea De Vito, University of Sassari, Sassari, Italy. It was published online on January 28, 2026, in HIV Medicine.

LIMITATIONS:

The study had a small sample size and a single-center design, potentially limiting the generalizability of the findings to more diverse populations. The relatively short follow-up period of 48 weeks may not have been sufficient to detect subtle changes in body composition or long-term metabolic effects. 

DISCLOSURES:

The study did not receive any external funding, and the authors declared having no conflicts of interest related to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.