Long-Acting Injectable Antiretroviral Therapy for HIV Management
Summary
Long-acting injectable antiretroviral therapy (LAI-ART) represents a paradigm shift in HIV management by offering intramuscular administration of potent drug combinations at extended intervals—typically monthly or bimonthly—in place of daily oral regimens. The principal agents in current use are cabotegravir, an integrase strand transfer inhibitor, and rilpivirine, a non-nucleoside reverse transcriptase inhibitor. Delivered as separate gluteal or alternative-site injections, this dual-drug approach maintains sustained plasma concentrations above therapeutic thresholds, thereby promoting durable virological suppression and reducing the risk of missed doses. Key advantages include enhanced adherence, improved treatment satisfaction and discretion for people living with HIV, and potential alleviation of pill fatigue. Implementation studies have demonstrated feasibility across diverse healthcare settings, though attention to cold-chain logistics, appointment scheduling and injection tolerability remains essential. As access expands globally, LAI-ART is poised to address barriers related to stigma, adherence challenges and polypharmacy, while stimulating further research in pharmacokinetics, resistance monitoring and long-term safety.
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Long-Acting Injectable Antiretroviral Therapy for HIV Management publication trend
The graph below shows the total number of articles in long-acting injectable antiretroviral therapy for hiv management across all publications each year (not limited to Nature Index journals).
Technical terms
Long-acting injectable antiretroviral therapy (LAI-ART): Antiretroviral drugs formulated for intramuscular administration at extended intervals to maintain viral suppression.
Cabotegravir: An integrase strand transfer inhibitor delivered via long-acting injection to block HIV integration into host DNA.
Rilpivirine: A non-nucleoside reverse transcriptase inhibitor formulated for long-acting administration to inhibit viral replication.
Trough concentration: The lowest plasma drug level measured immediately before the next scheduled dose, critical for assessing sustained efficacy.
Virological suppression: Reduction of HIV RNA in plasma to below a defined threshold, typically <50 copies/mL, indicating effective control of viral replication.
References
- Real-world trough concentrations and effectiveness of long-acting cabotegravir and rilpivirine: a multicenter prospective observational study in Switzerland. The Lancet Regional Health - Europe (2023).
- Perspectives of people living with HIV‐1 on implementation of long‐acting cabotegravir plus rilpivirine in US healthcare settings: results from the CUSTOMIZE hybrid III implementation‐effectiveness study. Journal of the International AIDS Society (2022).
- Perspectives of healthcare providers on implementation of long‐acting cabotegravir plus rilpivirine in US healthcare settings from a Hybrid III Implementation‐effectiveness study (CUSTOMIZE). Journal of the International AIDS Society (2022).
- Virological Failure After Switch to Long-Acting Cabotegravir and Rilpivirine Injectable Therapy: An In-depth Analysis. Clinical Infectious Diseases (2024).
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