A major African trial suggests that changing how HIV treatment is delivered could significantly improve viral suppression in adolescents.
Young people with HIV were more likely to keep the virus suppressed when they received treatment by injection every eight weeks instead of taking a pill every day, according to a randomized trial conducted across four African countries.
After just under two years (96 weeks), confirmed viral rebound occurred in only two adolescents (1%) receiving long-acting injectable therapy, compared with 15 (6%) taking daily tablets. Viral rebound means HIV levels in the blood rise after previously being suppressed, which can threaten long-term health and increase the risk of transmission.
A Different Way to Deliver HIV Treatment
The LATA (Long-Acting Treatment in Adolescents) trial included 476 adolescents aged 12 to 19 at five clinics in Kenya, South Africa, Uganda and Zimbabwe. Participants were randomly assigned either standard daily tablet treatment or injections of cabotegravir and rilpivirine every eight weeks.
All participants had already taken tablet-based antiretroviral therapy for more than a year, had fully suppressed HIV (undetectable), and had no previous treatment failure. Almost all had acquired HIV at birth.
Although HIV cannot currently be cured, antiretroviral drugs can suppress the virus to very low levels, allowing people to live long, healthy lives while greatly reducing the chance of transmitting HIV to others. About 1.6 million adolescents (aged 10 to 19 years of age) are living with HIV worldwide.
Daily Pills Can Be Harder for Adolescents
Adolescents with HIV have historically had more difficulty maintaining successful treatment than adults. Daily medication can create practical challenges, while stigma or bullying may make taking pills especially difficult for young people.
Professor Sarah Pett (UCL Innovative Clinical Trials Unit), Chief Investigator of the LATA trial, said: “HIV-positive adolescents as a group have historically done worse on antiretrovirals compared to adults. There is bullying and stigma associated with taking pills every day. Long-acting injectables taken every two months can help young people to lead a more normal life.
“The benefits of this form of treatment for adolescents [are] stronger than we have seen for adults. Previous trials in adults have shown only that injectables are no less effective than tablets.
“Our results support making injectables more widely available to groups such as adolescents who may not do so well on daily tablets. Nine out of 10 adolescents with HIV live in Africa, yet currently this treatment is not accessible to them.”
Most Participants Preferred the Injections
The clinical results were accompanied by a strong preference for the injectable treatment. Nearly all (94%) adolescents in the long-acting injectable group said receiving injections every eight weeks was much easier than taking medication every day.
When viral load rises, HIV can begin reproducing more actively. Persistent increases can damage health and expand the reservoir of dormant cells infected with HIV. In some circumstances, loss of viral suppression can also increase the possibility of transmitting the virus to partners or offspring.
The findings, published in The Lancet, go beyond earlier adult trials, which had generally shown that long-acting injections were no less effective than daily tablets. In this adolescent trial, the injections produced better viral suppression than standard oral treatment.
Access Remains a Major Barrier
Despite the results, long-acting injectable HIV treatment remains difficult to provide in many lower-resource settings. The medicines are still under patent and cost more than standard tablets, while rilpivirine requires refrigeration during transport and storage.
The injections must also be administered by trained nursing staff every eight weeks. People taking tablets may need clinic appointments only every three or six months. No agreement has yet been reached on a generic version of the injectable treatment.
Adolescents aged 12 and older, as well as adults, can already receive the injections in the United States, Europe and other high-income settings. Across Africa, however, access is largely limited to a small number of clinics.
Global HIV Guidelines Could Change
The World Health Organization currently recommends long-acting injections as an “alternative” option for adults and adolescents whose virus is successfully suppressed on daily tablets and who do not have active hepatitis B. The LATA findings could provide additional evidence for expanding their use among adolescents.
Corresponding author Dr Deborah Ford (UCL Innovative Clinical Trials Unit) said: “The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care, leaving most people living with HIV without access to treatments that are available in high-income settings.
“This gap may widen further with second- and third-generation injectables being trialled that may require doses just twice a year.”
Dr Mutsa Bwakura-Dangarembizi, trial physician and Principal Investigator of the site in Harare, Zimbabwe, said: “The LATA trial finding that the eight-weekly injections were much better for keeping the virus undetectable, were well tolerated and strongly preferred by adolescents, is really exciting news. But we have a major problem right now in Africa and in other low-and-middle income settings, where these long-acting injectables are simply not available for use. This problem needs to be addressed to enable us to use these injectables in the groups that need them the most, i.e., adolescents living with HIV.”
Reference: “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” by Mutsa Bwakura-Dangarembizi et al., 17 September 2026, The Lancet.
DOI: 10.1016/S0140-6736(26)01537-0
The trial received funding from the European Union through EDCTP-2 (the second European and Developing Countries Clinical Trials Partnership) and Johnson & Johnson Innovative Medicines. Johnson & Johnson Innovative Medicines provided the injectable rilpivirine, and ViiV Healthcare provided injectable cabotegravir. The sponsor was UCL.
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