HIV Injections Beat Daily Pills for African Teenagers, Major Trial Finds

A trial spanning Kenya, South Africa, Uganda and Zimbabwe found that teenagers living with HIV maintained viral suppression better on long-acting injections containing cabotegravir and rilpivirine than on daily oral treatment.

The findings, published in The Lancet, come from the LATA trial, which followed 476 adolescents aged 12 to younger than 20 at five clinics across the four countries.

Nearly all of the participants — 466, or 98% — had acquired HIV vertically.

They had already been on antiretroviral treatment for a median of 11.7 years and had maintained a viral load below 50 copies per mL for more than 12 months before entering the trial.

Participants were randomly assigned to either continue taking a daily combination of dolutegravir, lamivudine and tenofovir disoproxil fumarate, known as TLD, or switch to long-acting cabotegravir-rilpivirine injections.

Those receiving the injections received cabotegravir 600 mg and rilpivirine 900 mg by intramuscular injection at weeks 4, 8 and 16, followed by injections every eight weeks.

What the researchers found

Over the 96-week period used for the trial's primary outcome, only 2 of the 235 adolescents in the injection group experienced confirmed viral rebound, compared with 15 of the 241 adolescents who remained on daily pills.

The trial defined confirmed viral rebound as two consecutive HIV viral-load measurements of at least 50 copies per mL.

The estimated proportion experiencing viral rebound was 0.9% among those receiving the injections, compared with 6.4% among those taking daily pills.

The difference was statistically significant, with a p value of 0.0013.

The injection regimen first met the trial's criteria for non-inferiority and then demonstrated superiority over daily TLD for maintaining virological suppression.

The participants were followed for a median of 120 weeks overall.

Safety remained similar

The researchers found similar overall safety profiles between the two treatment groups.

There were 14 serious adverse events among participants in the injection group, compared with 18 in the daily-pill group.

Grade 3 or higher adverse events occurred in 27 participants receiving injections and 26 receiving daily pills.

Four grade 3 or higher injection-site reactions were reported in the injection group.

Injection-site reactions were a known feature of the injectable treatment, although most were not severe.

The only treatment-related serious adverse event was a hypersensitivity reaction.

Seven participants permanently discontinued the injectable treatment during follow-up.

The reasons included one confirmed viral load of at least 200 copies per mL, two treatment-related adverse events, one case of tuberculosis, two participants who were planning pregnancy and one participant who chose to stop treatment.

No new safety concerns were observed during the study.

Why long-acting treatment matters for teenagers

Adolescents living with HIV can face particular challenges maintaining treatment, and the LATA researchers note that this age group has poorer treatment outcomes than other age groups.

Daily treatment can create challenges around adherence, stigma and the increasing independence of adolescents as they move through school and into adulthood.

Long-acting treatment removes the need to take an HIV pill every day, replacing daily medication with clinic-based injections every eight weeks after the initial doses.

The LATA findings are notable because previous studies in adults have generally shown that long-acting cabotegravir-rilpivirine is no less effective than daily oral treatment.

In this adolescent trial, the injectable regimen was statistically superior to daily TLD for maintaining virological suppression.

An access gap in the region where it matters most

About 9 in 10 adolescents living with HIV are in sub-Saharan Africa, where access to long-acting HIV treatment remains limited.

The medicines also present practical challenges for health systems. Rilpivirine long-acting injection requires refrigerated storage, while administering the treatment requires trained healthcare workers and regular clinic visits.

Cost and availability remain important barriers to wider use.

ViiV Healthcare has licensed long-acting cabotegravir for HIV treatment through the Medicines Patent Pool, allowing generic manufacturers to develop the medicine for eligible countries.

However, generic development, regulatory approval and widespread availability of the complete cabotegravir-rilpivirine injectable regimen remain separate steps.

What happens now

The World Health Organization already recommends long-acting cabotegravir-rilpivirine as an alternative treatment option for adults and adolescents with HIV who have an undetectable viral load on oral treatment and do not have active hepatitis B infection.

The LATA findings provide additional randomised evidence supporting its use as a maintenance treatment option for adolescents who are already virally suppressed.

The results do not show whether the injectable treatment would work in adolescents whose HIV is not yet suppressed.

The trial specifically enrolled young people who had already maintained viral suppression for more than 12 months and had no previous treatment failure.

Wider implementation will also depend on the cost and availability of the medicines, as well as the capacity of health systems to deliver regular injections and maintain the required supply and storage systems.

The trial was funded by the European and Developing Countries Clinical Trials Partnership, Janssen and the UK Medical Research Council. Janssen and ViiV Healthcare supplied injectable study medicines.

University College London sponsored the trial; the researchers reported that the funders had no role in the study design, data collection, analysis, interpretation or writing, although company staff reviewed the manuscript before submission.

The findings therefore provide evidence for a specific group: adolescents with HIV who are already doing well on oral treatment and have maintained viral suppression.

They do not establish the injectable regimen as a replacement for daily treatment for every adolescent living with HIV.

Source: Bwakura-Dangarembizi M, Chappell E, Kityo C, et al. Switch to injectable cabotegravir-rilpivirine given every 8 weeks in adolescents living with HIV with virological suppression in sub-Saharan Africa (LATA): a randomised, open-label, multicentre, 96-week non-inferiority trial. The Lancet. Published 17 September 2026. doi:10.1016/S0140-6736(26)01537-0.