Long-Acting, Injected HIV Medications Show Promise for Challenging Cases

Antiretroviral pills have long been the cornerstone of HIV treatment, effectively controlling the infection. However, certain patients, such as those dealing with homelessness, drug addiction, or mental illness, struggle to adhere to a daily pill regimen. Dr. Monica Gandhi and her team have conducted a study to explore the potential of long-acting, injected HIV medications in addressing these challenges.

HIV medication

Exploring Long-Acting, Injected HIV Medications

Dr. Gandhi’s study aimed to investigate the effectiveness of long-acting injections of antiretroviral therapy (ART). These injections offer an alternative treatment option for patients who face obstacles in adhering to a daily pill routine due to competing priorities or underlying conditions. The FDA has already approved Cabenuva, the first injectable ART regimen, which combines multiple antiretroviral drugs administered once a month or every other month.

The Catch: Current Limitations of Injectable ART

Currently, injectable ART is only approved for HIV patients with controlled viral loads. There is a lack of research on the effectiveness of long-acting ART for patients with uncontrolled viral loads due to adherence issues. This limitation emphasizes the need to investigate the potential of long-acting therapies in this specific patient population.

Study Details and Encouraging Results

Dr. Gandhi’s team conducted a study involving 133 HIV patients in San Francisco between 2021 and 2022. Over two-fifths of the participants were not taking oral ART at the study’s start and had uncontrolled HIV viral loads. The remaining participants were using oral ART and had achieved viral suppression. The study included a diverse range of patients, predominantly men, and a significant proportion from minority groups. All participants received care at UCSF Ward 86, a renowned HIV clinic in San Francisco.

Promising Findings: Maintaining Viral Suppression

The results of the study were encouraging. Among patients who entered the study with suppressed viral loads through oral ART. All of them maintained control over their HIV with long-acting ART. Among those with uncontrolled HIV at the start of the study, nearly 98% achieved viral suppression with long-acting ART. This represents a significant achievement for patients who previously struggled to maintain control over their HIV. Homeless patients, in particular, responded positively to the convenience of injections, no longer burdened with carrying oral pills.

Considerations and Future Directions

While the study’s findings are promising, further research and larger trials are necessary to expand the approval of long-acting treatments. The goal is to obtain FDA approval for long-acting therapies for patients with adherence difficulties and uncontrolled viral loads. However, it’s important to acknowledge that injectable therapy may not be suitable for everyone, and patient preferences and circumstances should be considered when deciding on the treatment approach.

Expert Commentary and Editorial Insights

Dr. Simeon Kimmel, a co-author of the study’s accompanying editorial, commented on the findings. He recognized the challenges associated with injections and stressed the importance of ensuring scheduled delivery to prevent medication resistance. Dr. Kimmel emphasized that long-acting medications can be effectively delivered to specific patient groups with adherence difficulties when adequate resources and support are provided.

Promising Future Prospects for HIV Treatment

Dr. Gandhi’s study sheds light on the potential of long-acting, injected HIV medications in addressing the challenges faced by patients with adherence difficulties. The positive results observed in San Francisco offer hope for improving treatment outcomes and quality of life in HIV care. As research progresses and larger trials are conducted, long-acting ART holds promise as a viable option for patients who struggle with pill adherence and seek alternative treatment methods.

Beyond addressing adherence challenges, long-acting HIV medications offer benefits for patients in various situations, irrespective of their ability to adhere to a daily pill regimen. Improved adherence plays a crucial role in successful HIV treatment, reducing the risk of viral resistance and disease progression.

Homeless patients, in particular, have shown a positive response to long-acting ART. Managing health becomes more challenging for this population due to limited access to stable housing and reliable healthcare. The convenience of receiving injections during clinic visits can alleviate some of these challenges. This study’s focus on patients in San Francisco, where homelessness and substance abuse are prevalent, underscores the potential impact of long-acting ART in addressing the specific needs of vulnerable populations.

Further research and larger trials are necessary to expand the availability of long-acting HIV medications. These studies will deepen our understanding of their effectiveness, safety, and long-term outcomes. By identifying specific patient populations that can benefit the most, these treatments can be tailored to meet diverse patient needs and ensure effective and appropriate care.


Dr. Monica Gandhi’s study highlights the potential of long-acting, injected HIV medications in overcoming adherence challenges. The findings hold promise for enhancing HIV treatment and care, offering a pathway to improved adherence, reduced pill burden, and better health outcomes for individuals facing barriers to adherence. With ongoing research and advancements, long-acting ART emerges as a valuable option in the future of HIV treatment.


  • Dr. Phillip O.Coffin

    Phillip O. Coffin, M.D., M.I.A., F.A.C.P., is the Director of Substance Use Research at the San Francisco Department of Public Health. He is board-certified in internal medicine, infectious diseases, and addiction medicine; specific foci of Dr. Coffin’s training include general infectious diseases, HIV and viral hepatitis, buprenorphine maintenance, addiction management, and drug poisoning.