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Bimonthly HIV shots match daily pills — even for tough-to-treat patients. A phase 3b trial in Africa found that long-acting cabotegravir-rilpivirine injections every 8 weeks were just as effective as daily oral therapy in maintaining viral suppression among people with HIV who had struggled with adherence. Real-world data from over 7,000 U.S. patients backs this up, with 94% remaining virally suppressed and only 1% experiencing treatment failure.
Long-acting injectable HIV therapy is proving its worth — not just in ideal trial conditions, but in the real world too. A phase 3b randomized trial across Kenya, South Africa, and Uganda found that bimonthly injections of cabotegravir plus rilpivirine were noninferior to daily oral dolutegravir-based therapy in maintaining viral suppression at 48 weeks among adults who had previously struggled with adherence or staying engaged in care. A separate single-arm study in South African youth (ages 12–24) showed similarly impressive results, with 95.5% achieving viral suppression and zero confirmed virologic failures. A 5-year real-world U.S. study of nearly 7,000 patients confirmed the pattern: 94% remained virally suppressed at their final test, with only a 1% confirmed virologic failure rate.
Across all studies, injection-site reactions were common but mild, and rarely caused anyone to stop treatment. Notably, 93.6% of participants in the African trial preferred injections over their previous daily pills, and every participant who completed the South African youth study chose to continue the injections.
Key Takeaways:
Why it matters: For the millions of people with HIV who struggle with daily pill regimens, long-acting injectables offer a clinically equivalent — and often preferred — alternative. These converging data from trials and real-world settings could help overcome provider hesitancy and expand access to a treatment approach that puts patients' needs first.
