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Background The onset of adverse events (AEs) is the main cause of discontinuation of long-acting (LA) cabotegravir+rilpivirine (CAB+RPV) in observational and randomized studies. Nevertheless, data are scarce on the choice of the following oral regimen, on the potential additional AEs that develop during the pharmacokinetic tail of CAB and RPV, and on the virologic outcomes in people who discontinue LA treatment for reasons other than virologic failure (VF).Materials and Methods This is a multicenter, prospective, observational study conducted within the SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) project; it includes people with HIV (PWH) who discontinued LA CAB/RPV therapy after at least one follow-up visit. Descriptive statistics were used to summarize data.Results The study included 700 PWH on LA CAB+RPV, with an observed all-cause therapy interruption rate of 13.3% (93/700) and a median follow-up of 23 months (IQR 14-30). The main reasons for treatment discontinuation were AEs and the subject’s decision, accounting for 47.3% (44/93) and 16.1% (11/93) of all interruptions, respectively ( table 1). Injection site reactions (ISRs) were the most frequent AE, accounting for 45.5% of cases, followed by arthromyalgias and infectious complications, each accounting for 11.4% of cases (table 2). Excluding people who were lost to follow-up and the deceased, we evaluated the oral regimen selected after LA discontinuation in the remaining study participants. Among the subgroup that discontinued injectables for reasons other than VF, and excluding one subject who returned to the same PI-based therapy that was in place before initiating LA, 100% maintained a NNRTI- and/or INSTI-based regimen without the need to introduce new ARV classes or a PI-based therapy. Considering those who discontinued injectables due to VF, 4 out of 10 people switched to a PI-based regimen (table 3).The resumption of the same drug co-formulation utilized before the LA regimen occurred in 20.0% (2/10), 76.9% (15/65), and 84.1% (37/44) of PWH who interrupted LA due to VF, due to any cause other than VF, and due to AEs, respectively. Overall, 92.1% of regimens after LA interruption were NNRTI (16%), INSTI (57.3%), or NNRTI+INSTI (18.7%)-based. No new AEs were recorded after switching back to oral therapy throughout the whole cohort. Six months after resuming oral therapy, HIV-RNA loads <30 copies/mL and <200 copies/mL were recorded in 96.0% (72/75) and 98.7% (74/75) of individuals, respectively.Conclusions Among individuals who interrupted injectables for reasons other than VF, the majority returned to the same pre-LA oral co-formulation. The superimposition of CAB+RPV pharmacokinetic tail with an oral NNRTI and/or INSTI-based regimen did not lead to the development of AEs, even in people with a previous AE to CAB or RPV. Six months after the reintroduction of oral therapy, the virologic suppression rate was high throughout the cohort.Abstract SC22 Table 1–3