A new study from UC San Francisco researchers suggests that patients who have trouble taking daily HIV medications may benefit from long-acting injectable treatments. This approach could also help curb the spread of HIV by reducing the number of people with infectious diseases.

In 2021, federal regulators approved the first long-acting antiretroviral (LA-ART) injection, a combination of long-acting cabotegravir and rilpivirine. However, it is only approved for HIV patients who have achieved viral suppression with oral medications.

UCSF researchers sought to determine whether this treatment would also work for patients whose infections cannot be controlled with medications—whether due to difficulty swallowing, memory problems, lack of stable housing, or other challenges such as substance use disorders.

So they gave these patients monthly or bimonthly injections and compared their viral loads with other patients who had already controlled their viral loads with oral medications before starting injectable HIV treatment.

More than 98% of participants in both groups achieved what's called "viral suppression," meaning undetectable HIV levels, after 48 weeks. This is the largest and longest-running apples-to-apples comparison. The paper was recently published in the Journal of the American Medical Association.

The research, supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, may help stop the spread of HIV because people who are virally suppressed cannot spread the virus. This is a huge change for patients who have difficulty adhering to multiple medications they take every day.

"These long-acting treatments have the potential to be transformative for this population," said Matthew Spinelli, MD, assistant professor in the Department of AIDS, Infectious Diseases and Global Medicine at UCSF and lead author on the paper. "We have patients who have been suffering from disease for years, and when we inject them with the drug, it works like magic. We're excited to see success in a population we worry about the most."

The publication of the JAMA article coincides with the presentation of the research results at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco from March 9 to 12. This annual conference brings together researchers from around the world who focus on HIV/AIDS and related diseases.

To conduct this assessment, the researchers relied on patient data from the Special Project on Long-Acting Antiretroviral Drugs to Stop HIV (SPLASH) in Ward 86 of the UCSF AIDS Clinic at Zuckerberg San Francisco General Hospital.

They looked at data from 370 patients between January 2021 and September 2024, of whom 129 had detectable viral load levels when they started injecting the drug, while 241 did not.

About 11 months later, 99% of patients who were virally suppressed when they started taking the drug still had no detectable HIV virus in their blood. Results were essentially the same for patients who started injecting the drug before the virus was under control: 98% achieved viral suppression during that time.

The U.S. Department of Health and Human Services and the U.S. International Antiviral Association have updated their guidance to recommend this strategy, in part because of the UCSF data, said the paper's senior author Monica Gandhi, MD, MPH, professor of medicine, associate director of the Division of HIV, Infectious Diseases and Global Medicine at UCSF and medical director of the District 86 AIDS Clinic.

"We hope our findings will encourage health care providers across the country to use long-acting ART for patients with detectable viral loads and adherence challenges," she said. "It actually works."

Compiled from /ScitechDaily

DOI:10.1001/jama.2025.0109