Conference Coverage

Long-Acting Cabotegravir PrEP Linked to Higher Coverage, Lower HIV Incidence

Edited by:
Ashton L. Stahl

Key Highlights

  • Median PrEP coverage was 93% with CAB-LA vs 58% with oral PrEP over approximately 11–12 months of follow-up.
  • One HIV acquisition occurred during CAB-LA use compared with 181 cases during oral PrEP use.
  • Demographics were similar across groups, although Medicare/Medicaid enrollment was more common among CAB-LA users.

Investigators at the 2026 Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, CO, presented findings from the US-based OPERA cohort showing higher pre-exposure prophylaxis (PrEP) coverage and lower HIV acquisition rates among individuals receiving cabotegravir long-acting (CAB-LA) injections compared with oral PrEP. The analysis assessed real-world PrEP coverage and HIV incidence in routine clinical care settings.

CAB-LA, administered every 2 months, has previously demonstrated superior efficacy compared with daily oral PrEP in clinical trials. In this observational cohort study, researchers evaluated whether differences in PrEP coverage and HIV acquisition were observed in clinical practice.

The study included adults without HIV who received at least 1 CAB-LA injection and/or an oral PrEP prescription between December 21, 2021, and June 30, 2024, in the OPERA cohort. Participants could contribute multiple PrEP episodes, defined as continuous use of CAB-LA or oral PrEP. Switching between tenofovir disoproxil fumarate/emtricitabine and tenofovir alafenamide/emtricitabine was permitted within an oral PrEP episode.

Each episode was censored, as early as June 30, 2025, and labeled as death, loss to follow-up, PrEP type switch, or 12 months after episode initiation. PrEP coverage was defined as the proportion of days covered over cumulative follow-up days. For CAB-LA, covered days were calculated as the minimum of the days between injections and the end of the injection window (37 days for initiation and 67 days for maintenance), cumulatively across injections. For oral PrEP, coverage was determined based on prescription duration and refills. Incidence rates and incidence rate ratios for HIV acquisition were estimated using univariate Poisson regression.

Study Findings

A total of 39,037 individuals contributed 1,911 CAB-LA PrEP episodes and 39,221 oral PrEP episodes. Age, sex, and race distributions were comparable between groups, although Medicare or Medicaid enrollment was more common among CAB-LA users.

Median PrEP coverage was 93% (IQR, 81–100) over a median 11 months of follow-up for CAB-LA users, compared with 58% (IQR, 25–94) over a median 12 months for oral PrEP users. Within 12 months of PrEP initiation, 1 HIV acquisition occurred among CAB-LA users—after 3 months of use and without an HIV test before initiation—corresponding to an incidence rate of 0.9 per 1,000 person-years (95% CI, 0.1–6.5). In contrast, 181 HIV acquisitions occurred among oral PrEP users, yielding an incidence rate of 5.0 per 1,000 person-years (95% CI, 4.3–5.7). The incidence rate ratio for HIV acquisition was 5.40 (95% CI, 0.76–38.51) for oral compared with CAB-LA PrEP.

Clinical Implications

According to the study authors, PrEP coverage for CAB-LA in this real-world US cohort was excellent and considerably higher than for oral PrEP. HIV acquisition while on PrEP was rare overall, with more than fivefold lower, though not statistically significant, rates observed during CAB-LA use compared with oral PrEP use. The authors stated that these findings underscore the importance of PrEP access and formulation options in efforts to end the HIV epidemic.

Expert Commentary

“In this real-world cohort of PrEP users in the US, PrEP coverage for CAB LA PrEP was excellent, and considerably higher than for oral PrEP. HIV acquisition while on PrEP was rare, with >5 times lower rates (non-statistically significant) during CAB LA PrEP use compared to oral PrEP use. These findings confirm the importance of PrEP access and formulation options to end the HIV epidemic,” the researchers concluded.

Reference

Brunet L, Barnett SK, Fusco J, et al. Comparing PrEP coverage and HIV acquisition between CAB LA and oral PrEP in the OPERA cohort. Presented at: 2026 Conference on Retroviruses and Opportunistic Infections; February 22–25, 2026; Denver, CO.