Once-weekly vs once-daily HIV treatment: What’s the difference?

How would a once-weekly pill compare with the daily HIV treatment currently used in South Africa? A new once-weekly HIV treatment is in the spotlight as it is showing promise in clinical trials, raising the possibility that some people living with HIV could one day take their medication once a week instead of every day. The development comes as researchers increasingly explore long-acting HIV treatments that could reduce the frequency of medication while maintaining viral suppression.

Taking antiretroviral medication every day is still a central part of HIV treatment in South Africa. The Department of Health’s National Consolidated HIV Guidelines recommend antiretroviral therapy for people living with HIV, with treatment aimed at achieving and maintaining viral suppression. The guidelines include dolutegravir-based treatment, with dolutegravir taken once daily alongside other antiretroviral medicines in commonly used regimens.

Daily treatment is already established and forms part of South Africa’s national HIV programme. However, for many people, remembering to take medication every day can be challenging. Forgetting doses, travelling, maintaining privacy and managing medication as part of a daily routine can all affect how often one takes it.

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The new treatment combines two medicines, islatravir and lenacapavir, in an investigational oral regimen designed to be taken once a week. Results from the Phase 3 ISLEND-1 trial found that the once-weekly treatment maintained viral suppression in adults living with HIV who were already virally suppressed and switched from their existing daily treatment. At 48 weeks, the weekly treatment was found to be non-inferior to Biktarvy, a daily HIV treatment.

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