What Are Long-Acting HIV Medications?

Newer HIV medications require fewer doses. Here’s how they work and why some people may want to explore this option.

HIV medications have greatly improved over the decades, and newer medications may offer better regimen options for people living with HIV.

Human immunodeficiency virus (HIV) is a chronic viral infection that destroys cells of the immune system. Left untreated, HIV will weaken the immune system until it can no longer fight off infectious agents (like bacteria and other viruses) and certain cancers. This can lead to a condition known as acquired immunodeficiency syndrome (AIDS).

There are excellent medications that can suppress an HIV infection and prevent the progression to AIDS, allowing people with HIV to live long and healthy lives. To work effectively, these medications must be taken exactly as prescribed—which is sometimes difficult. They must also be taken for the rest of a person’s life.

HIV medications have greatly improved over the decades, and newer medications may offer better regimen options for people living with HIV.

Here, we look at how HIV medications work, what HIV medications are available, and what HIV medications are under development.

Antiretroviral therapy (ART)

HIV is classified as a retrovirus, and the types of drugs that target HIV are known as antiretroviral drugs. Treatment for HIV is known as antiretroviral therapy (ART).

HIV is very prone to mutating as it replicates, which allows it to evade the immune system and develop resistance against drugs. As a result, no one drug is effective against HIV for very long.

To combat this, multiple types of antiretroviral drugs—which attack HIV in different ways—are given at the same time. A combination of antiretroviral drugs is called a regimen.

Early forms of ART involved taking many different pills at specific times during the day. Following the drug schedule exactly is essential to giving ART the highest likelihood of success, and these early complicated regimens could prove difficult for people with HIV.

Beginning in the late 1990s, pharmaceutical companies were able to consolidate ART into fixed-dose combination pills. This resulted in a great reduction in the number of medications a person with HIV needed to take daily, with many forms of ART requiring only a single type of tablet.

Simplifying ART in this way leads to a significant improvement in patient adherence to the regimen, which in turn can lead to better outcomes.

New, long-acting ART drugs

In early 2021, the U.S. Food and Drug Administration approved a new ART regimen which can simplify the treatment of HIV even further. It consists of a monthly injection into the muscle (like a flu shot) and contains a mix of two different ART medications which are designed to work gradually over the course of a month.

So far, this regimen has only been approved to treat people with HIV for whom traditional ART is already working well. Before beginning the injections, people with HIV must take the two component medications in pill form for one month.

Other medications for both the treatment of HIV and the prevention of HIV are under development, including other long-acting ART medications, new classes of medications, and new delivery systems for medications.

Remember, HIV is a different experience for every person, and different approaches to treatment work for different people. Your best source of information when making any treatment decision will be your healthcare provider.

Article sources open article sources

Centers for Disease Control and Prevention. About HIV.
Centers for Disease Control and Prevention. HIV Treatment.
National Institute of Allergy and Infectious Disease. Antiretroviral Drug Discovery and Development.
National Human Genome Research Institute. Retrovirus.
Redmond P.Smyth, Miles P.Davenport, and Johnson Mak. The origin of genetic diversity in HIV-1. Virus Research, 2012. Vol. 169, No. 2.
UpToDate. Patient education: Initial treatment of HIV (Beyond the Basics).
Sripal Bangalore, Gayathri Kamalakkannan, Sanobar Parkar, and Franz H. Messerli. Fixed-Dose Combinations Improve Medication Compliance: A Meta-Analysis. The American Journal of Medicine, 2007. Vol. 120, No. 8.
U.S. Food & Drug Administration. FDA Approves First Extended-Release, Injectable Drug Regimen for Adults Living with HIV. January 21, 2021.
Darcy Jimenez. HIV treatment: are long-acting therapies the future?. Pharmaceutical Technology. June 24, 2021.
Melanie A. Thompson. Gilead, Merck begin phase 2 study of weekly two-drug HIV regimen. Healio. October 28, 2021. Long-Acting HIV Prevention Tools.
Bill Snow. The Rise of Broadly Neutralizing Antibodies. AVAC. May 17, 2018.
Gary Maartens and Andrew Boulle. CD4 T-cell responses to combination antiretroviral therapy. The Lancet, 2007. Vol 370, No. 9585.

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