HIV injections work better than tablets for young people, clinical trial finds
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Young people living with HIV manage their condition better when their antiretroviral therapy is given by injections every eight weeks rather than daily tablets, according to results of a trial in Africa led by UCL (University College London) researchers.
In a paper published in The Lancet, the team found that the injections were more effective at keeping the virus suppressed than tablets and called for efforts to make this treatment more accessible worldwide.
Although HIV is currently incurable, antiretrovirals can help people live long, healthy lives and greatly reduce the risk of the virus being transmitted to others. About 1.6 million adolescents ages 10–19 live with HIV.
Sarah Pett (UCL Innovative Clinical Trials Unit), chief investigator of the LATA trial, said, "HIV-positive adolescents as a group have historically done worse on antiretrovirals compared to adults. There is bullying and stigma associated with taking pills every day. Long-acting injectables taken every two months can help young people lead a more normal life.
"The benefits of this form of treatment for adolescents are stronger than we have seen for adults. Previous trials in adults have shown only that injectables are no less effective than tablets.
"Our results support making injectables more widely available to groups such as adolescents who may not do so well on daily tablets. Nine out of 10 adolescents with HIV live in Africa, yet currently this treatment is not accessible to them."
Trial tests injectable treatment
The LATA (Long-Acting Treatment in Adolescents) trial was conducted in five clinics in Kenya, South Africa, Uganda and Zimbabwe. It involved 476 adolescents ages 12–19 who were randomly assigned to either a daily tablet, which is standard care, or a long-acting injectable (cabotegravir and rilpivirine), a relatively new way to treat HIV.
Those participating in the trial had been on tablet treatment for more than a year, had HIV that was fully suppressed (undetectable) and had not previously experienced treatment failure. Almost all participants in LATA had had HIV since birth.
The research team found that, after just under two years (96 weeks), only two adolescents (1%) receiving injectables experienced confirmed viral rebound (two viral load measurements taken at least seven days apart), in which the amount of virus in the blood increases, compared with 15 (6%) in the daily-tablet group. Increases in viral load can harm people's long-term health by increasing the number of dormant cells infected with HIV and, in some cases, can lead to the infection being passed on to partners or offspring.
Nearly all adolescents (94%) in the long-acting injectables group said the eight-weekly injections were much easier than taking medicines daily.
Barriers to African access
A few challenges need careful consideration regarding the use of long-acting injectables in lower-resource settings. The injectables are more expensive than standard daily tablets because the drugs are still under patent and cost more to make. In addition, rilpivirine needs to be kept refrigerated during supply and storage. Skilled nursing staff are also required to administer the injections every eight weeks, whereas appointments for people taking tablets may be as infrequent as every three or six months. There is no agreement yet on a generic version of the injectable treatment.
Currently, adolescents 12 and older, as well as adults, can be prescribed the injectables in the U.S., Europe and other high-income settings. But in Africa, except for a few clinics, the treatment is not yet available.
The World Health Organization currently recommends the injectables as an "alternative" option for adults and adolescents taking daily tablets who are successfully suppressing their virus and do not have active hepatitis B. This stance may be strengthened as a result of the LATA trial findings.
Risk of widening inequalities
Corresponding author Dr. Deborah Ford (UCL Innovative Clinical Trials Unit) said, "The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care, leaving most people living with HIV without access to treatments that are available in high-income settings.
"This gap may widen further with second- and third-generation injectables being trialed that may require doses just twice a year."
Mutsa Bwakura-Dangarembizi, trial physician and principal investigator of the site in Harare, Zimbabwe, said, "The LATA trial's finding that the eight-weekly injections were much better at keeping the virus undetectable, were well tolerated and were strongly preferred by adolescents is really exciting news. But we have a major problem right now in Africa and other low- and middle-income settings, where these long-acting injectables are simply not available for use. This problem needs to be addressed to enable us to use these injectables in the groups that need them most, that is, adolescents living with HIV."
Publication details
The Lancet (2026).
Journal information: The Lancet
Clinical categories
Infectious diseasesHIV & AIDSPediatricsChildren's health Provided by University College London Who's behind this story?
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