Injectable HIV Treatments

Reviewed by: HU Medical Review Board | Last reviewed: December 2022

Currently there is no cure for HIV, but with treatment, it can be well controlled. Through treatment, HIV can become undetectable. People with HIV should start treatment as soon as possible. Standard HIV treatment includes antiretroviral therapy (ART).1,2

In 2021, the US Food and Drug Administration (FDA) approved an injectable formula for HIV treatment. Now people living with HIV have the option for treatment through a pill regimen or shots (injections) given by a doctor. As research into HIV treatment continues, self-administered shots may be available in the future.1,3

Current HIV treatment options

Antiretroviral treatments provide effective therapy when taken as directed. ART has greatly reduced the number of HIV-related deaths in the past 40 years. There are 2 types of HIV treatment options available: pills and shots given by a doctor.1,4

HIV treatment pills

Pills are recommended for people who are starting therapy. There are many FDA-approved single-pill and combination drugs available. Pills must be taken daily.1,2

HIV treatment shots

The shots are doses of long-acting drugs that a doctor injects at routine office visits. Injections can be given either once a month or once every other month.1

What kind of HIV therapy is available by injection?

Shots can be used both to treat HIV and to prevent transmission.5

Treatment

The long-acting injection for HIV treatment is a blend of 2 drugs. It is a combination of cabotegravir and rilpivirine.2-5

Cabotegravir is an integrase inhibitor. This type of drug blocks an enzyme (a kind of protein) that HIV needs to make copies of itself. Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). NNRTIs stick to and change an enzyme that HIV needs to make copies of itself.2-5

Rilpivirine is also used in pill form as an HIV treatment.5

Prevention

Injectable, long-acting cabotegravir can be used for pre-exposure prophylaxis (PrEP). People who do not have HIV can use the shots to help avoid transmission. The injections for PrEP are as effective as pills if not more so.6,7

How effective are injectables for HIV treatment?

HIV treatment shots are as effective as HIV treatment pills. Studies show that monthly injections are as effective as daily pills. And treatment shots given every 2 months are as effective as shots given monthly.5,7

Injections of the long-acting drugs keep viral suppression low. Injection treatment can help with viral suppression, both for people just starting ART and for those who switch from a pill regimen.5,8,9

Are shots a good option for everyone?

Long-acting injections could be a good treatment option for adults living with HIV who:1

  • Have an undetectable viral load
  • Have no history of treatment failure
  • Do not have a known allergy to the drugs

What are the implications of injectable HIV treatment?

People living with HIV now have options for managing their chronic condition. This means more people could have access to therapy and use it as directed. Because combination ART can prolong life expectancy, access to more treatment options could help save lives.3,8

Long-acting injectable treatment may simplify therapy for people with HIV. Shots offer another option for people with HIV. Shots opens the door to treatment for people who are not able to swallow pills or have issues absorbing drugs in pill form.5,7,8

Injectable treatment could help with some of the side effects of pills. It can also help for people who have a hard time sticking to their pill regimen.7

Access to long-acting shots could benefit people with HIV who:5

  • Are homeless
  • Are in prison
  • Are traveling
  • Want or need to keep their status private

Self-given HIV treatment shots may be on the horizon

A drawback of using shots for HIV treatment is the need for frequent doctor visits. But in the future, new formulations of the HIV injectable therapy and alternative injection sites could allow people to give themselves shots at home. Self-administered shots could help overcome one of the main obstacles to wider adoption of long-acting injectables.5

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