The Future of Long-Acting Therapies in Reaching Unsuppressed Patients

Despite major advances in HIV treatment, a persistent gap remains: a subset of patients who are not virologically suppressed, often due to challenges with adherence, stigma, or engagement in care. Long-acting therapies such as cabotegravir plus rilpivirine (CAB+RPV LA) may play a pivotal role in addressing this unmet need—but important questions remain about how best to use them in this population.
Current clinical trial data largely focus on patients who are already suppressed at initiation, leaving a gap in evidence for those who begin treatment with active viremia. While emerging real-world and early study data suggest that some viremic patients can achieve suppression with long-acting therapy, larger, more rigorous studies are needed to confirm these findings and guide clinical decision-making. Key considerations include identifying appropriate viral load thresholds, assessing resistance risk, and establishing standardized protocols for initiating therapy in this group.
Beyond individual patient outcomes, the broader potential of long-acting therapies lies in improving engagement across the HIV care continuum. For patients who struggle with daily oral medications—whether due to stigma, lifestyle factors, or treatment fatigue—injectable options offer a way to reduce the burden of adherence and maintain consistent care.
Looking ahead, experts anticipate that long-acting and extended-duration therapies will become increasingly central to HIV management. By offering new ways to reach and retain patients in care, these innovations could help close the gap toward universal viral suppression and reshape the future of HIV treatment.