Abstract
Background: Adolescents and young adults living with HIV often face adherence challenges due to psychosocial, developmental, and structural barriers. This study examined whether the mode of HIV transmission—vertical vs. horizontal—impacts adherence or viral suppression in youth receiving long-acting cabotegravir–rilpivirine within a specialty pharmacy-supported pediatric/adolescent HIV outpatient clinic.
Methods: A retrospective, cohort analysis was conducted on patients aged 13–23 who received at least six bimonthly cabotegravir-rilpivirine injections from October 1, 2022, to October 1, 2024. Patients were classified by transmission mode and monitored for adherence and viral load. Adherence was defined as receiving each injection within ±7 days of the 56-day treatment interval. Patients who switched to monthly dosing, changed therapy due to drug interactions, or became pregnant were excluded.
Results: A total of 45 patients met inclusion criteria (14 vertically acquired, 31 horizontally acquired). Adherence was 100% in the vertical group and 99% in the horizontal group (p = 0.31). All patients established and/or maintained viral suppression (HIV-1 RNA <200 copies/mL). However, mean viral load differed significantly: 128.1 copies/mL in the vertical group vs. 1.8 copies/mL in the horizontal group (p = 0.01), despite both being within suppressed ranges.
Conclusions: High adherence and virologic suppression were observed in both groups, with no clinical difference in transmission mode. Specialty pharmacy care may play a critical role in supporting long-acting injectable antiretroviral therapy (LAI – ART) success in youth living with HIV.
Keywords
HIV, Adherence, Youth, Specialty pharmacy