A new once-weekly HIV treatment is showing encouraging results in clinical studies. This opens up the possibility for people living with HIV to take medication weekly instead of daily.
A new once-weekly HIV treatment is showing encouraging results in clinical studies. This opens up the possibility for people living with HIV to take medication weekly instead of daily.
The development of these long-acting treatment methods allows researchers to reduce the frequency of medication intake while maintaining viral suppression.
Currently, the standard in South Africa is the daily intake of antiretroviral drugs. The Ministry of Health recommends antiretroviral therapy for people living with HIV to achieve and maintain viral suppression. These recommendations include treatment based on dolutegravir, which is taken daily along with other antiretrovirals in established regimens.
Daily intake is already established and is part of the national HIV control program in South Africa. However, it can be difficult for many patients to remember their daily doses; forgetfulness, travel, the need for confidentiality, and managing medication within daily routines can affect adherence.
The new treatment combines two drugs—itrastvir and lenacapavir—in an investigational oral regimen designed for once-weekly administration. Phase 3 trial results from ISLEND-1 showed that weekly treatment maintained viral suppression in adults living with HIV who were already virally suppressed and transitioned from existing daily treatment. After 48 weeks, the weekly treatment was no worse than Biktarvy, a daily HIV treatment.
A second Phase 3 study, ISLEND-2, also investigated this weekly combination in individuals who had already achieved viral suppression and switched from the daily standard of care. It should be noted, however, that these results do not mean the weekly pill is yet available to patients. The treatment remains experimental, and developers plan to submit the clinical trial data to regulatory bodies for review.
The most obvious difference is the frequency of dosing. Patients on standard daily oral HIV treatment must take medication every day. The investigational treatment reduces this frequency to one dose per week, which may ease treatment for some individuals who struggle with a daily medication schedule. Furthermore, reducing the frequency does not mean adherence becomes less important; the weekly treatment must still be taken according to the prescribed schedule.
Additionally, the approaches differ in accessibility. Daily treatment is already integrated into the South African healthcare system, whereas the weekly combination has not yet been approved for routine use.
The weekly pill is part of a broader trend toward HIV medications that do not require daily dosing. According to the U.S. National Institutes of Health, long-acting HIV drugs can already be administered at intervals ranging from two weeks to six months, depending on the specific drug.
The World Health Organization has also recommended long-acting injectable drugs cabotegravir and rilpivirine as an alternative switching option for eligible individuals who have achieved full viral suppression on oral therapy. South Africa is also implementing long-acting injectable lenacapavir for HIV prevention. It is important to distinguish between prevention and treatment: using a drug to prevent HIV does not guarantee that the same product is available or approved for treating people who already have HIV.
This could potentially simplify treatment for some patients. The WHO has highlighted adherence challenges associated with daily oral treatment and believes that long-acting HIV drugs can offer benefits such as reduced dosing frequency, convenience, and privacy. At the same time, the WHO has pointed out issues such as cost, accessibility, drug resistance, and implementation within the healthcare system as critical aspects when introducing long-acting HIV drugs.
Thus, the weekly pill could serve as an intermediate solution between daily pills and long-acting injectable methods: medication would still be taken at home, but much less frequently.
No. The new data does not imply that people living with HIV should stop taking their current medications or change their treatment. Existing HIV treatment guidelines in South Africa remain in effect, and the weekly combination is still in the research phase. The new study points toward a future where people with HIV may have more treatment options, depending on regulatory approval, clinical suitability, and availability. For now, people living with HIV should continue taking their medication as prescribed and consult their healthcare provider before making any changes to their treatment.
Despite headlines about a new once-a-month drug for HIV prevention, global experts warn that the medication is still in clinical trials and is not yet available for widespread use.
This information emerged following an agreement between Aspen Pharmacare and the American pharmaceutical company MSD. This partnership aims to increase the availability of the investigational drug, known as alimatravir, across the entire African continent, pending regulatory approval. Aspen stated plans to manufacture, market, and distribute this medicine on the African continent, thereby supporting efforts to improve access to HIV prevention technologies.
Alimatravir is an investigational oral agent being studied as a form of pre-exposure prophylaxis (PrEP). PrEP refers to medications taken by HIV-negative individuals to reduce the risk of infection. The difference between alimatravir and the existing oral PrEP in South Africa is that the new drug is designed to be taken only once a month, whereas the current oral PrEP requires daily intake.
Currently, Alimatravir is not sold in South Africa. The drug is still being evaluated within Phase III clinical trials to determine its safety and efficacy. For it to be approved for use in South Africa, it requires authorization from the country's national drug regulator—the South African Health Products Regulatory Authority (SAHPRA). Until such approval is obtained, residents of South Africa are advised to continue using established HIV prevention methods recommended by healthcare professionals.
At this stage, alimatravir does not replace existing prevention methods. Daily oral PrEP remains one of the most effective forms of protection for people at high risk of HIV infection when adherence to the regimen is maintained. Other prevention methods mentioned include condom use, post-exposure prophylaxis (PEP), male circumcision, and regular HIV testing. Internationally, long-acting injectable PrEP has also emerged, although access to it varies by country. If the drug is approved, it will add another option rather than replacing current prevention methods.
South Africa faces one of the world's largest HIV epidemics. According to UNAIDS data, millions of South Africans live with HIV, and thousands of new infections are recorded annually. Health experts consistently emphasize that expanding the range of preventive options is critical, as different medications suit different people and lifestyles. A once-monthly drug could make HIV prevention more convenient for some individuals who find it difficult to take pills daily. Nevertheless, specialists caution that additional evidence is required for this drug to be included in standard HIV prevention programs.
Aspen noted that this agreement could strengthen Africa's capacity to produce advanced medicines closer to where they are needed. The COVID-19 pandemic highlighted the continent's dependence on imported vaccines and medicines, which spurred renewed efforts to build up pharmaceutical manufacturing capacity in Africa. Localizing the production of HIV prevention drugs can contribute to increasing the long-term reliability of supplies and ensuring faster access if regulatory approvals are granted.
The results of the ongoing Phase III clinical trials will determine the possibility of submitting alimatravir to regulatory bodies for approval. If successful, regulatory authorities, including SAHPRA, will evaluate the presented evidence before deciding on the drug's usability in South Africa. Until then, health authorities urge people at risk of HIV to continue using proven prevention methods and consult with medical specialists regarding the suitability of existing PrEP options for them.
