Increasing CD4/CD8 ratio confirmed after two years of long-acting cabotegravir and rilpivirine in the SCohoLART study

Background Long-acting (LA) cabotegravir plus rilpivirine (CAB/RPV) is an established maintenance option for virologically suppressed people with HIV (PWH), but long-term real-world data on immune balance and cardio-metabolic and renal markers remain limited. This study evaluated immunologic, metabolic and renal changes in PWH switching to LA CAB/RPV. Methods SCohoLART is a single-center prospective cohort enrolling virologically suppressed adults switching to every-2-month LA CAB/RPV. Baseline characteristics were summarized using medians (IQR) or proportions. Longitudinal changes were estimated using linear mixed-effects models to derive crude annual mean slopes (95% confidence interval; 95% CI). Participants initiating or discontinuing statins during follow-up were excluded from lipid analyses. Multivariable analysis assessed the impact of prior antiretroviral therapy (ART) backbone on immunologic outcomes. Results A total of 549 participants were included (91.3% male; median age 48.9 years [39.7–56.3]; median prior ART exposure 11.3 years [7.9–17.3]) with a median LA follow-up of 24.0 months (IQR17.0–26.8). At switch, median CD4/CD8 ratio was 0.98 (0.70–1.28), with CD4 and CD8 counts of 795 (604–994) and 850 cells/µL (642–1113). The CD4/CD8 ratio increased by 0.05/year (95% CI 0.04–0.06; p<0.001), driven by declining CD8 counts (−27.90 cells/µL/year; p<0.001), while CD4 counts remained stable. Total and low-density lipoprotein cholesterol decreased modestly (−1.72 and −4.40 mg/dL/year). Estimated glomerular filtration rate increased (+1.16 mL/min/1.73 m²/year) and creatinine decreased (−0.04 mg/dL/year). Weight and body mass index were unchanged. Conclusion Switching to LA CAB/RPV was associated with improved CD4/CD8 ratio and modest favorable lipid and renal trends over 24 months.