How Long-Acting Injectables Are Changing HIV Care

Long-acting injectable (LAI) HIV medications are reshaping how clinicians and patients approach both prevention and treatment, particularly for those who struggle with the demands of a daily pill.

Matthew H. Herrmann, MD, AAHIVS, an infectious disease specialist and internist who serves as chief medical and research officer and managing director at Pacific Oaks Medical Group, helps patients navigate these decisions in his own practice. In an interview with The American Journal of Managed Care^® (AJMC^®), Herrmann discussed the stigma and gaps in awareness that keep some patients from starting or staying on HIV treatment or pre-exposure prophylaxis (PrEP) and how long-acting injectables can ease that burden.

He also addressed the practical considerations clinicians should walk through with patients, common misconceptions about injectable therapy, and how open conversation can help patients feel empowered to choose an approach they can maintain long-term.

This transcript was lightly edited for clarity.

AJMC: What are some of the biggest challenges you see in helping patients start and remain consistent with HIV treatment or PrEP, and where can long-acting injectable options help address those challenges?

Herrmann: One of the main hurdles I see in my practice is stigma surrounding HIV testing, prevention, and treatment. Stigma can contribute to fear of judgment, concerns about unintended disclosure, or fear of being associated with HIV and cause some people to delay testing, avoid conversations about prevention, including PrEP [pre-exposure prophylaxis], or disengage from routine HIV care that supports viral suppression.

In addition, limited awareness and education about the treatment and prevention options available can prevent many from finding and staying adherent to their therapy. Some patients may be unaware of the available treatment approaches, including long-acting injectable options. Without clear information, they may find it difficult to make an informed choice that fits their lives.

For some patients, being on a long-acting injectable can help reduce the burden of daily medication and has been shown to improve adherence and persistence compared with oral therapy, which can mean continuous viral suppression or protection from HIV.

This is why educational efforts such as ViiV Healthcare’s "Do It For Future You" campaign are so important. By encouraging people to think about their future health and start conversations about testing, prevention, and treatment, campaigns like this may help normalize care and make available options easier to understand.

AJMC: For patients who are considering a long-acting injectable option, what factors should clinicians discuss when determining whether this approach is a good fit for their lifestyle, preferences, and care needs?

Herrmann: Determining whether a long-acting injectable is right for someone comes down to shared decision-making. When I sit down with a patient, we look at their daily routine, their travel schedules, and whether they can commit to periodic clinical visits. We also talk candidly about privacy and explore the emotional weight of pill-taking. We discuss if taking pills brings anxiety or unwanted reminders of HIV or HIV status.

On the clinical side, I always review all of a patient's current medications, including over-the-counter supplements or prescription drugs, to assess for potential drug interactions and contraindications. We also talk through what the injection experience is like and discuss potential adverse events.

AJMC: How does the experience of managing HIV with a long-acting injectable differ from oral regimens, particularly when it comes to adherence, follow-up, and, in treatment, maintaining viral suppression?

Herrmann: At its core, it shifts adherence from a daily task at home into a routine together with a care team. With daily oral regimens, adherence relies on a person successfully remembering a pill 365 days a year. Whereas with long-acting injectables like cabotegravir plus rilpivirine [Cabenuva; ViiV Healthcare] for HIV treatment and cabotegravir [Apretude; ViiV Healthcare] for HIV prevention, regular clinic appointments are scheduled, and, as long as patients maintain these appointment schedules, I have visibility into medication adherence.

Periodic office visits with LAI medications can also provide consistent touchpoints where doctors and patients can strengthen their relationship, and providers can closely monitor overall wellness. During these appointments with my patients, I can easily perform routine STI [sexually transmitted infection] screenings in line with clinical guidelines and address evolving health needs in real time.

AJMC: What should patients know about the practical aspects of long-acting injectable treatment or prevention, including dosing schedules, administration, and the importance of keeping appointments?

Herrmann: From a practical standpoint, long-acting injectables are administered by a health care provider in a clinic setting. Long-acting products also have lead-in or loading regimens before patients can assume a more regular schedule of injections. For example, dosing schedules for both Cabenuva for treatment and Apretude for PrEP include initiation doses followed by injections given once every 2 months.

What patients need to know is that keeping these injection appointments is essential. Because these medications work over an extended period, staying on schedule helps ensure continuous viral suppression or protection. In our clinic, we work flexibly with patients to schedule appointments.

AJMC: Are there particular misconceptions or concerns about injectable HIV treatment or prevention that you frequently encounter in clinical practice, and how do you address them with patients?

Herrmann: One major misconception I hear frequently is the idea that injectables are only for people who are struggling with oral pills or failing treatment. In the early days of these medications, some viewed them as a niche option, but today we know long-acting injectables may be an option for eligible patients who may prefer less frequent dosing or a different dosing routine that matches an active lifestyle.

Some patients wonder if an injection is truly as effective as a daily pill. Clinical data have shown that when administered as prescribed, injectables are effective.^1-4 Clearing up these misconceptions helps patients make informed decisions that best suit their needs.

AJMC: What role does the clinician-patient conversation play in helping patients feel comfortable discussing HIV prevention or treatment options, particularly when stigma or concerns about disclosure may affect their willingness to seek care?

Herrmann: The conversation between a clinician and a patient is the foundation of care. In communities impacted by HIV, stigma and fear of disclosure remain real barriers. If a patient feels uncomfortable or judged, they may walk away from care entirely.

Clinicians must take the lead. We cannot wait for patients to raise these topics; we need to proactively normalize sexual health as a routine part of comprehensive wellness. I approach my patients with open dialogue, empathy, and direct transparency.

Personally, I want my patients to feel that taking control of their sexual health is an act of empowerment, not something to hide. When we reframe care around a patient's personal motivations by asking them what kind of life they want to build, we help them connect today's health care choices with a thriving future.

AJMC: As more HIV prevention and treatment options become available, what do you think clinicians can do to make sure patients understand their choices and feel empowered to select an approach they can maintain long-term?

Herrmann: To empower patients, clinicians must first broaden their own view of who is a candidate for long-acting options and offer them options proactively.

Second, we need to practice true shared decision-making. That means presenting the full spectrum of options, including daily pills and long-acting injectables, and discussing their benefits, dosing schedules, and safety profiles in a clear, accessible way.

Finally, we should connect patients with educational tools and campaign resources like ViiV Healthcare's ForFutureU.com. These platforms offer culturally relevant information and practical discussion guides that help patients feel confident driving conversations with their health care team.

When patients see that the decisions they make today shape their tomorrow, they feel truly empowered to choose an approach they can maintain for the long haul.

Author Disclosures: Matthew H. Herrmann, MD, AAHIVS, is compensated by ViiV Healthcare.

References

1. Ramgopal MN, Castagna A, Cazanave C, et al. Efficacy, safety, and tolerability of switching to long-acting cabotegravir plus rilpivirine versus continuing fixed-dose bictegravir, emtricitabine, and tenofovir alafenamide in virologically suppressed adults with HIV, 12-month results (SOLAR): a randomized, open-label, phase 3b, non-inferiority trial. Lancet HIV. 2023;10(9):e566-e577. doi:10.1016/S2352-3018(23)00136-4

2. Overton ET, Richmond G, Rizzardini G, et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with human immunodeficiency virus type 1 infection: 152-week results from ATLAS-2M, a randomized, open-label, phase 3b, noninferiority study. Clin Infect Dis. 2023;76(9):1646-1654. doi:10.1093/cid/ciac1068

3. Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med. 2021;385(7):595-608. doi:10.1056/NEJMoa2101016

4. Delany-Moretlwe S, Hughes JP, Bock P, et al. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomized clinical trial. Lancet. 2022;399(10337):1779-1789. doi:10.1016/S0140-6736(22)00538-4