Is Long-Acting HIV Treatment as Effective as Daily Pills? Experts Weigh In
HIV treatment has undergone a significant transformation over the years, allowing those living with HIV to lead normal, healthy lives. Antiretroviral therapy (ART) has made it possible for people with HIV to maintain undetectable viral loads, effectively eliminating the risk of transmission to others. However, the requirement to take daily pills for life can be a challenging commitment for some individuals.
Recently, long-acting injectable treatments have emerged as a promising alternative to the daily regimen of oral medications. These treatments, administered monthly or bi-monthly, have been shown to be as effective as daily oral pills. Despite the encouraging results, there remains a slight risk of virological failure, and, in rare cases, drug resistance.
One of the key voices on this topic, Dr. Jurgen Kurt Rockstroh, Head of Infectious Diseases at the University Hospital Bonn in Germany, addressed these concerns during the 16th National Conference of AIDS Society of India (ASICON 2025) in Ahmedabad, India. Dr. Rockstroh, who has extensive experience in HIV care, emphasized the positive impact of ART on those living with HIV.
“Over 95% of people diagnosed with HIV and placed on first-line oral ART quickly achieve viral suppression with an undetectable viral load,” he said. “This means there is zero risk of transmission, which is often referred to as ‘undetectable equals untransmittable’ (U=U).”
Dr. Rockstroh highlighted that for most people on ART, the long-term prognosis is excellent, with near-normal life expectancy for those who stay virally suppressed. However, he also acknowledged that adhering to daily ART can be difficult for some, especially for individuals facing stigma or challenges with pill swallowing.
“The need for new options stems from the difficulties some people face with daily medication. HIV-related stigma, the risk of disclosure, and treatment fatigue are just some of the barriers that people encounter,” Dr. Rockstroh said. “In some cases, patients simply do not want to be reminded of their HIV status every day.”
He shared the story of a woman from an African nation, under his care in Germany, who opted for long-acting injectable therapy to maintain her HIV status confidential. “She chose this treatment because, in her community, disclosure could result in discrimination or exclusion,” Dr. Rockstroh explained. “She continues to be virally suppressed and healthy.”
Studies have shown growing interest in alternative treatment regimens. A 2018 study among 263 people with HIV found that 61% of participants preferred the option of taking a single pill once a week, while 34% expressed interest in injectable treatments administered every two months.
Dr. Rockstroh emphasized that the introduction of long-acting HIV treatments offers people more choices. He noted that these treatments, such as cabotegravir and rilpivirine injections, have proven to be as effective as daily oral therapies. “For individuals who struggle with daily pills or have issues related to HIV stigma, long-acting treatments could provide a vital alternative,” he said.
However, while long-acting options are promising, there are still risks involved. Even fully adherent individuals may experience virological failure, which could lead to drug resistance. Dr. Rockstroh urged that long-acting treatments be considered for those who are already virologically suppressed or stable on ART but may struggle with adherence.
“Injectable treatments expand the choices for those facing challenges with daily oral therapy,” Dr. Rockstroh said. “However, it is essential to note that virological failure, even with full adherence, is still a risk.”
As research continues to evolve and more data becomes available, experts agree that access to the latest HIV treatment options should be a priority. Dr. Rockstroh concluded, “Ensuring access to the latest regimens is crucial, and all available treatment options must be accessible to those who are eligible.”
With long-acting injectables becoming more widely available, the future of HIV treatment looks promising, offering people living with HIV greater flexibility and choice in managing their condition.
