Long-Acting HIV Treatment Holds Up in South African Youth

TOPLINEYoung people living with HIV in South Africa who switched to long-acting injectable antiretroviral therapy (ART) with cabotegravir and rilpivirine maintained viral suppression at week 48, with 95.5% having a viral load < 50 copies/mL. Nearly all participants remained in the study, none had confirmed virologic failure, and everyone who reached week 48 chose to continue the injections.METHODOLOGYResearchers conducted a nonrandomized, single-arm study at a community research site in Cape Town to assess whether long-acting injectable ART with cabotegravir and rilpivirine was acceptable, tolerable, and feasible for young people living with HIV aged 12-24 years.A total of 134 participants (median age, 20 years; 62.7% assigned female at birth) switched to injections of cabotegravir and rilpivirine: 59 had already achieved viral suppression on daily pills, 35 had suboptimal adherence, and 40 were ART naive.Before switching, participants were required to have a viral load < 50 copies/mL. They then received intramuscular injections of 600 mg cabotegravir and 900 mg rilpivirine every 8 weeks for 48 weeks.Acceptability and tolerability were measured on the basis of the frequency and severity of drug-related adverse events. Feasibility was measured on the basis of the proportion of injections administered within 7 days before or after the target date.Viral suppression (viral load < 50 copies/mL) was assessed at week 48. Virologic failure was defined as two consecutive viral loads ≥ 200 copies/mL.TAKEAWAYAt week 48, 127 of 133 (95.5%) participants had a viral load < 50 copies/mL: This included 94.9% of those who had already achieved viral suppression on daily pills, 97.1% of those with prior difficulties with adherence, and 95.0% of those who were ART naive. No participant had confirmed virologic failure.Of 794 follow-up injections, 774 (97.5%) were administered within 7 days before or after the target date. A total of 132 of 134 (98.5%) participants attended the week 48 visit, and all of them chose to continue the injections.Injection site reactions were reported by 100 participants; these reactions most often involved pain or tenderness (reported by 67.9% of participants at week 4) and were mostly reported early during treatment. All reactions were mild or moderate (grade 1 or 2), except one grade 3 infection that resolved with oral antibiotics.Four participants had brief, sudden-onset reactions after injection that resolved on their own, and none had anaphylaxis. None of the drug-related adverse events reported led to the discontinuation of the injections. Two serious adverse events were reported, but both were judged to be unrelated to the study drugs.IN PRACTICE"The exceptionally high rates of viral suppression and retention highlight the potential of LAI-ART [long-acting injectable ART] to transform HIV treatment outcomes among YLHIV [young people living with HIV], who have historically struggled to remain engaged in care," the authors wrote.SOURCEThe study was led by Chantel Schreuder, MBChB, University of Cape Town, Cape Town, South Africa. It was published online on September 24, 2026, in JAIDS Journal of Acquired Immune Deficiency Syndromes.LIMITATIONSThe study ran as a clinical trial with research resources and compensation for participants, which may limit how well the results apply to routine clinics. A trial team supported participants and could call and trace anyone who missed a visit. Moreover, the researchers did not test for drug resistance before treatment began.DISCLOSURESThe study was funded by Johnson & Johnson. One author reported honoraria for advisory work from ViiV Healthcare, Merck, and Gilead Sciences. Another reported honoraria from MSD for advisory boards, and a third reported honoraria from ViiV Healthcare.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.