HIV Injections May Work Better Than Daily Tablets for Young People, Lancet Study Finds

Young people living with HIV may achieve better viral control with long-acting injections given every eight weeks than with daily antiretroviral tablets, according to a new study published in The Lancet. The findings suggest that injectable treatment could offer a more convenient option for adolescents who find taking medicines every day difficult.

The Lancet study, known as the Long-Acting Treatment in Adolescents (LATA) trial, included 476 adolescents aged 12 to 19 years from Kenya, South Africa, Uganda and Zimbabwe. All participants had HIV that was already suppressed with treatment and had no previous treatment failure.

Injections Kept HIV Suppressed For Longer

Participants were randomly divided into two groups. One group received long-acting injections containing cabotegravir and rilpivirine every eight weeks, while the other continued taking a daily combination of dolutegravir, lamivudine and tenofovir.

After 96 weeks, only two participants in the injectable group experienced confirmed viral rebound, compared with 15 participants in the daily tablet group. This means viral rebound occurred in about 1% of those receiving injections compared with about 6% of those taking daily tablets. The researchers concluded that the injectable treatment was superior at maintaining viral suppression in this group.

Viral suppression is an important goal of HIV treatment because it keeps the amount of virus in the blood at very low levels and helps protect long-term health.

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Why Injections May Be Easier For Adolescents

Taking HIV medicines every day can be challenging for young people. Forgetting doses, concerns about stigma and the need to take tablets regularly may affect treatment adherence.
The study found that 94% of adolescents receiving the long-acting injections said the eight-weekly treatment was much easier than taking medicines every day. Researchers noted that reducing the need for daily tablets could help young people manage HIV treatment with less disruption to their daily lives.

Most participants had acquired HIV at birth, meaning they had already spent many years taking antiretroviral treatment before entering the trial.

Potential Challenges with Injections

Although the results are encouraging, long-acting injectable treatment is not equally available everywhere. The medicines are more expensive than standard tablets, and rilpivirine needs refrigeration during storage and transport. The injections also need trained healthcare workers to administer them every eight weeks.

Injection-site reactions, mainly pain or discomfort, were reported in some participants, but most were mild and settled within a few days. Overall, the study did not identify new safety concerns with the injectable treatment.

Around nine in 10 adolescents living with HIV are estimated to live in Africa, yet access to long-acting injectable treatment remains limited in many African settings. Researchers say improving access could help address differences in HIV treatment outcomes among young people.

Final Word 

The findings indicate that eight-weekly cabotegravir and rilpivirine injections could provide an effective alternative to daily tablets for adolescents whose HIV is already well controlled. However, availability, cost, refrigeration, and access to trained healthcare workers remain important barriers to wider use.