HIV Prevention and Treatment Enter New Era with Long-Acting Options

• HIV prevention and treatment are shifting from daily pill regimens to long-acting, less frequent options like twice-yearly injectable lenacapavir and weekly oral combinations.
• PURPOSE 1 and 2 studies confirm high efficacy for injectable lenacapavir as PrEP, with participants preferring it over daily medication.
• ISLEND-1 and 2 trials demonstrate that a weekly combination of islatravir and lenacapavir can replace daily treatment for people living with HIV.

Clinical Significance

• Long-acting options aim to improve adherence by fitting around patients' lives rather than mandating rigid schedules.
• Weekly regimens reduce the psychological burden by lessening the frequency of reminders regarding HIV-positive status.
• Choice remains central; experts emphasize that different populations may prefer different methods—injections, weekly pills, or daily pills—allowing for a person-centered approach similar to family planning.

Implementation Challenges

• Breakthroughs in science require supporting systems including political commitment, affordable pricing, and robust supply chains.
• Funding cuts in low- and middle-income countries complicate the integration of new options into primary healthcare systems.
• Healthcare providers require specialized training to effectively guide patients through available choices.
• Generic manufacturing via voluntary licensing is a key component of access strategies, but success depends heavily on national financing and implementation capacity.

Future Outlook

• Gilead Sciences and other stakeholders are focusing on regulatory pathways and partnerships with organizations like the Global Fund to ensure equitable access.
• Community-led design and rollout are deemed essential for the effective integration of these medicines into diverse health systems.
• Further innovation is required to continue expanding the variety of long-acting tools available to those most at risk.