{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:10:58Z","timestamp":1792811458382,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100023181","name":"Medical Research Agency","doi-asserted-by":"publisher","award":["2024\/ABM\/03\/KPO\/KPOD.07.-IW.07-0042\/24-00"],"award-info":[{"award-number":["2024\/ABM\/03\/KPO\/KPOD.07.-IW.07-0042\/24-00"]}],"id":[{"id":"10.13039\/501100023181","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Recovery and Resilience Plan"},{"name":"field of medical and health sciences"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Virological failure (VF) with long-acting injectable cabotegravir and rilpivirine (CAB\/RPV-LA) is uncommon but often associated with selection of resistance, potentially limiting future treatment options. Registration trials associated VF risk with baseline RPV resistance, A1\/A6 subtypes, and body mass index (BMI) &amp;gt;30 kg\/m2, but these factors have rarely been analyzed in other clinical settings. We summarize the first \u223c100 reported VF cases, focusing on subtypes, drug levels, and resistance patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Published data on CAB\/RPV-LA through July 2025 were analyzed for risk factors. Resistance mutations were interpreted using the Stanford HIVdb database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After excluding duplicates, 94 VF cases were analyzed. Only 4.4% met the high-risk threshold of \u22652 risk factors. Subtype A lineages were reported in 26.4%, preexisting RPV mutations in 14.7%, and BMI &amp;gt;30 kg\/m2 in 36.9%. At failure, low CAB or RPV levels were observed in 29% but did not differ from treatment successes. Predicted reduced susceptibility to CAB or RPV was observed in 87.2% (56% for both), with CAB resistance mutation N155H more frequently observed among subtype A lineages. Predicted susceptibility to dolutegravir\/bictegravir (44.3%), doravirine (39.7%), or etravirine (35.9%) was common, but high-level resistance was rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergent resistance in VF cases often resulted in cross-resistance to other nonnucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors. Although most cases did not meet the high-risk profile as defined by registration trials, subtype A lineages were overrepresented. Low drug levels were not elevated versus treatment successes. These data suggest that subtype-specific factors beyond A6 may influence VF risk and merit further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag046","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T12:42:07Z","timestamp":1769604127000},"page":"1023-1031","source":"Crossref","is-referenced-by-count":5,"title":["Virological Failure on Long-Acting Injectable Cabotegravir and Rilpivirine: An Analysis of Subtypes, Drug Levels, Resistance, and Therapeutic Implications"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0263-0703","authenticated-orcid":false,"given":"Maria","family":"Mazzitelli","sequence":"first","affiliation":[{"name":"Dipartimento di Sicurezza e Bioetica\u2014Sezione di Malattie Infettive, Universit\u00e0 Cattolica del Sacro Cuore , Rome ,","place":["Italy"]},{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1869-1084","authenticated-orcid":false,"given":"Milosz","family":"Parczewski","sequence":"additional","affiliation":[{"name":"Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin , Szczecin ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7279-2818","authenticated-orcid":false,"given":"David","family":"Burger","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Pharmacology, and Toxicology, Radboud University Medical Center Research Institute of Medical Innovation , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3790-8891","authenticated-orcid":false,"given":"Annemarie","family":"Wensing","sequence":"additional","affiliation":[{"name":"Department of Global Health and Bio-Ethics, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Translational Virology , Utrecht ,","place":["The Netherlands"]},{"name":"Ezintsha, WITS RHI, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"2026070722323932600_ciag046-B1","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1056\/NEJMoa1909512","article-title":"Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection","volume":"382","author":"Orkin","year":"2020","journal-title":"N Engl J 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