Eight-week HIV injections outperform daily pills in African adolescent trial

Long-acting HIV treatment given by injection every eight weeks kept HIV suppressed more effectively than daily tablets in a randomised trial involving adolescents in South Africa and three other African countries.

The LATA trial enrolled 476 adolescents aged 12 to 19 at five clinics in South Africa, Kenya, Uganda and Zimbabwe. All participants already had virologically suppressed HIV, had been on antiretroviral treatment for at least a year and had no previous treatment failure.

Participants were randomly assigned either to continue daily oral treatment with dolutegravir, lamivudine and tenofovir, or to switch to long-acting injections of cabotegravir and rilpivirine every eight weeks.

After 96 weeks, confirmed viral rebound occurred in two of 235 adolescents in the injectable group, compared with 15 of 241 in the daily-tablet group — about 0.9% versus 6.4%.

The trial first met its statistical test for non-inferiority and then met the prespecified test for superiority for its primary outcome.

What the result does — and does not — show

The finding applies to adolescents whose HIV was already well controlled. It does not show that injections are a replacement for starting standard antiretroviral therapy in people with uncontrolled HIV, nor does it mean patients should change treatment without clinical assessment.

The primary outcome was confirmed viral rebound, defined as two consecutive viral-load measurements of at least 50 copies per millilitre by week 96.

No new safety concerns were identified, and serious adverse events occurred at similar rates in the two groups. One participant in the injectable group who experienced viral rebound developed resistance to cabotegravir and rilpivirine, underlining the importance of correct patient selection, scheduled dosing and viral-load monitoring.

The trial population was predominantly young people who had acquired HIV vertically. Seventy-one participants — 15% of the study population — were recruited in South Africa.

Treatment preference was also notable. Among participants who reported on treatment experience, 94% in the injectable arm said long-acting treatment was much easier to take than daily oral therapy.

The South African question is access

The clinical result is particularly relevant to South Africa because adolescents living with HIV can face adherence barriers linked to pill fatigue, stigma, mental health, changing family support and increasing independence.

Long-acting treatment could reduce the daily burden of taking tablets, but it replaces that burden with another requirement: reliable access to clinics for injections every eight weeks.

Cost, supply, cold-chain requirements, trained staff and clinic capacity will determine whether the trial result can translate into routine public-sector care.

The study therefore strengthens the evidence for long-acting treatment as a maintenance option for selected adolescents with suppressed HIV. It does not by itself establish when, how widely or at what cost the regimen should be rolled out in South Africa.

Sources: LATA trial / The Lancet; Radboud University Medical Center; ClinicalTrials.gov NCT05154747; trial data presented at AIDS 2026.