Long-Acting Antiretroviral Drug Therapy in Adolescents: Current Status and Future Prospects

Complete HIV suppression may be difficult to achieve in adolescents because of inadequate medication adherence. Cabotegravir-rilpivirine is the first complete long-acting injectable antiretroviral drug combination approved in the United States for adolescents. Injectable antiretroviral therapy holds the promise of improved adherence resulting in complete HIV suppression, which also has public health advantages. Approximately 50% of human immunodeficiency virus (HIV)-infected adolescents fail to achieve complete viral suppression, largely due to nonadherence to their antiretroviral drug regimens. Numerous personal, financial, and societal barriers contribute to nonadherence, which may lead to the development of HIV drug resistance. Long-acting antiretroviral drugs hold the promise of improved adherence because they remove the need for swallowing one or more pills daily. Cabotegravir (an integrase strand transfer inhibitor) and rilpivirine (a non-nucleoside reverse transcriptase inhibitor) can now be intramuscularly co-administered to HIV-infected adolescents every 4-8 weeks if they are virologically suppressed and without resistance mutations to cabotegravir or rilpivirine. Adverse effects are few and non-severe. Widespread use of this complete antiretroviral therapy may be limited by drug costs, need for sites and skilled personnel who can administer the injections, and ethical challenges. Other long-acting medications and new antiretroviral therapy delivery systems are under active investigation and show great promise.