Teenagers living with HIV who switched from daily pills to injections every eight weeks were far less likely to see the virus return, according to a randomized trial published in The Lancet. After 96 weeks, two adolescents on injections (1%) had confirmed viral rebound, compared with 15 (6%) who stayed on daily tablets. The researchers found the injections were more effective at keeping the virus suppressed, and a trial physician said they were well tolerated.
The LATA trial enrolled 476 young people ages 12 to 19 at five clinics in Kenya, South Africa, Uganda, and Zimbabwe. Every participant already had an undetectable viral load, had taken pills for more than a year, and had never experienced treatment failure. Almost all were born with HIV, a detail that shapes how widely the findings apply.
For American families, the result involves a treatment that already exists here. The injections combine two long-acting drugs, cabotegravir and rilpivirine, and adolescents 12 and older can already be prescribed them in the U.S., Europe, and other high-income settings, according to University College London, which led the study.
Two Rebounds Versus 15 After Nearly Two Years
Participants were randomly assigned to keep taking a standard daily tablet or to switch to injections given at a clinic every eight weeks after an initial ramp-up period. The study counted rebound when two tests at least seven days apart showed 50 or more copies of HIV per milliliter of blood, the level at which the virus is considered detectable, CIDRAP reported.
The gap in outcomes surprised the investigators. Chief investigator Sarah Pett told CIDRAP she had expected teens on injections to do about as well as those on pills, since earlier adult trials had shown only that injections were no worse than tablets. In this group of teens, the shots performed better, and 94% of those receiving them said the eight-week schedule was a lot easier than taking medicine every day.
Pett, of UCL's Innovative Clinical Trials Unit, pointed to the bullying and stigma teens face when taking pills every day. Long-acting injections, she said, "can help young people to lead a more normal life."
Rebound matters beyond a lab number. Rising viral levels can increase the number of dormant cells infected with HIV and, in some cases, allow the virus to pass to partners or babies.
Patients in San Francisco, Atlanta, and Chicago Report a Lighter Treatment Load
U.S. data published the same week point in a similar direction. A study in Open Forum Infectious Diseases surveyed patients receiving HIV treatment at clinics in San Francisco, Atlanta, and Chicago who got injections from a health care provider every four or eight weeks. Those patients said they preferred the injections to daily pills.
About three in four said their mental well-being was better on injections, CIDRAP reported. Not having to remember a daily pill was the most common reason for preferring the shots, followed by the injections being less work.
Natella Rakhmanina, MD, PhD, who directs HIV prevention and treatment services at Children's National Hospital in Washington, D.C., told CIDRAP her team has scaled up the injections for adolescents in U.S. clinical settings for more than four years. She said she would like the World Health Organization to recommend them for virally suppressed teens.
Elizabeth Lowenthal, MD, of Children's Hospital of Philadelphia, who did not contribute to the Lancet study, said the patients likely to benefit most are "those who struggle to take daily oral therapy consistently." She added that affordable prices and reliable supply chains are needed before the shots can reach resource-limited areas.
A Strong Trial in a Narrow Group
The study was a randomized, open-label, multicenter trial that was designed to test whether injections were no worse than pills, and it found they were better. Because it was open-label, participants knew which treatment they received. It included 476 adolescents in four African countries and did not test teens whose virus was not yet suppressed or young people in the United States.
Funding came from the European Union's EDCTP2 program and Johnson & Johnson Innovative Medicines. Johnson & Johnson supplied the injectable rilpivirine, ViiV Healthcare supplied injectable cabotegravir, and UCL sponsored the trial.
Current guidance has not changed overnight. The WHO lists the injections as an alternative option for adults and adolescents who are suppressed on daily tablets and do not have active hepatitis B, and the UCL team said that position may be strengthened.
Practical barriers remain real. The drugs cost more because they are still under patent and are more expensive to make; rilpivirine must stay refrigerated, and skilled nurses must give the shots every eight weeks. Patients on pills, by contrast, may visit clinics only every three to six months. No agreement on a generic version exists yet.
Corresponding author Deborah Ford warned that limited access in Africa risks widening inequalities in HIV care. She noted the gap could grow as next-generation injectables that may need dosing just twice a year move through trials.
For U.S. families, the finding supports a conversation rather than an immediate switch. Teens should not stop daily medication on their own, but families can ask their HIV clinician whether the teen qualifies, how insurance or assistance programs cover the injections, and whether an eight-week clinic schedule is realistic.
Teens who were already doing well on pills kept HIV suppressed better with shots every eight weeks. The results come from four African countries, however, and cost and clinic capacity will shape who benefits next.
Key Questions Answered
What did the LATA trial find?
Among 476 teens with suppressed HIV, 1% of those on injections every eight weeks had confirmed viral rebound after 96 weeks, compared with 6% on daily pills.
Who took part in the study?
Participants were ages 12 to 19 in Kenya, South Africa, Uganda, and Zimbabwe. All had undetectable virus on daily pills, and almost all were born with HIV.
Are these injections available in the United States?
Yes. Adolescents 12 and older can already be prescribed injectable cabotegravir and rilpivirine in the U.S., according to UCL.
Should a teen stop daily HIV pills and switch?
No one should stop HIV medication without talking to their clinician. Under WHO guidance, the injections are an option for people whose virus is suppressed on pills and who do not have active hepatitis B.
Who funded the research?
The European Union's EDCTP2 program and Johnson & Johnson Innovative Medicines funded the trial. Johnson & Johnson and ViiV Healthcare supplied the injectable medicines.
What stands in the way of wider use?
Higher cost, refrigeration needs, and clinic visits every eight weeks are the main barriers. No generic version has been agreed on yet.
