“Normal is the perfect word”: participants describe switching to weekly HIV treatment

Taking HIV treatment once a week may make it easier to fit into everyday life and reduce the daily reminder of living with the virus. In the ISLEND-2 study, most people who switched from daily treatment to an investigational weekly tablet containing islatravir and lenacapavir favoured their new regimen and the reasons for this went beyond convenience. 

These findings were reported in two poster presentations from the ISLEND-2 trial at the International Congress on Drug Therapy in HIV Infection (HIV Glasgow 2026) this week. Dr Moti Ramgopal and colleagues assessed treatment preferences, satisfaction and quality of life after a year. A separate poster by Professor Chloe Orkin and colleagues looked at participants’ and healthcare providers’ experiences through interviews.

One participant described how switching to a weekly tablet meant they did not have a daily reminder of living with HIV:

“In a way, it’s reminding me for years that, ‘Hey, you’ve got a condition. Okay, you’ve got a condition.’ But literally now, one pill a week, it’s like taking ibuprofen, let’s say. So, normal is the perfect word.” 

Because both drugs are cleared slowly and remain in the body for a long time, longer dosing schedules are possible. The combination could become the first complete HIV treatment taken as a once-weekly pill. 

Context

Both posters report additional analyses from ISLEND-2, a phase 3 trial involving people whose HIV was already suppressed on daily oral treatment. Participants were randomly assigned either to switch to weekly islatravir / lenacapavir or to continue their usual daily regimen. There were 314 people switched to weekly treatment and 312 continuing daily treatment. The study was open-label, meaning that participants and their clinicians knew which treatment they were receiving.

At one year, viral suppression was maintained in 95% of the participants in either group. With HIV remaining well controlled in both groups, the current two analyses explored the question of whether taking treatment less often makes everyday life easier for people with HIV.

Participants’ experiences

The characteristics of both groups (standard treatment vs once weekly) were very similar. The average (mid-point) age was 52 in the weekly treatment group and 53 in the daily treatment group, and the participants in both groups had been taking HIV treatment for around 15 years on average.

The participants completed questionnaires that assessed their experiences ranging from the convenience of taking their treatment and preference, to quality of life and overall health. 

Most were already taking relatively simple treatment – 88% were using a single-tablet regimen before enrolling into the study. So, for many, the change involved moving from one pill a day to one pill a week. After one year, 72% of the participants in the weekly treatment group strongly preferred it to their previous regimen.

Comparisons between the two groups also favoured weekly treatment. Around 68% of those taking islatravir / lenacapavir described themselves as ‘very satisfied’ with their current regimen, compared with 46% of those continuing daily treatment. Similarly, 82% of the weekly treatment group reported that their regimen was not at all burdensome in contrast to 61% of the daily-treatment group. 

The difference extended beyond convenience as only around 16% of people taking weekly treatment said their medication reminded them of their HIV status ‘very much’ or ‘quite a bit’, compared with 25% of those staying on daily treatment.

The participants’ medication-related worries and worries about other people finding out their HIV status also changed more favourably in the weekly treatment group. However, there was no difference between the two groups in the change in their ratings of their overall health. 

More participants in the weekly treatment group (86%) said they took their pill on the advised day and time all of the time, compared with 75% of those continuing daily treatment. 

Participant and healthcare provider interviews 

In the second analysis, interviews explored these experiences on a more individual level. Researchers interviewed 20 participants and ten healthcare providers in Australia, the UK and the United States before switching, with follow-up interviews at three months and at one year. The interviewees had an average age (mid-point) of 53 years, 18 of the 20 were men and 12 were White. Most of them (12) were from the US. 

Eighteen participants completed the final interviews. They highlighted practical benefits, including easier travel and fewer pills to pack. For some, taking treatment less often also offered more privacy.

“Even if I go for night out or whatever with the team or if I’m staying with some of my mates or whatever, I don’t have to carry any pills so I don’t have to disclose anything.”

Others described the emotional weight of being reminded of their HIV status, even when treatment was working well.

“Just for the fact that I’m not negative is a sad reminder for me because I look at my history and how everything came to be.…it reminds me less of my overall status even though my status is good.”

Despite taking fewer doses, participants need to find a way to remember them. Some of them described the ways they fitted the doses into their new routines.

“To make sure that you take it once a week, that’s going to be the biggest challenge. For me, right now, it’s Tuesdays are my days. I’ve already made it in my head. Tuesday – every time I hear Tuesday; Tuesday now means for me it’s time to take my medication.”

Others relied on their phone alarms, as a healthcare provider described: 

“Almost everybody’s got a mobile phone, and… can put up alarms on their mobile phones. Therefore, the concern of what people remember to take the medication at the right time/day I think is manageable.”

The healthcare providers interviewed generally felt that introducing weekly treatment would not require additional staff or clinic capacity, and their overall attitude was positive towards the weekly regimen. 

Concluding thoughts

Although these findings seem intuitive and expected, there are several reasons to interpret them with caution. The participants knew which treatment they were taking, so expectations may have influenced their experience and responses. Among those interviewed, 15 of the initial 20 already preferred less frequent treatment, and 17 had positive expectations about switching in general. In other words, their experiences may differ from those of people who might prefer an established daily routine. Besides, the participants may also have benefitted from support within the trial that would not necessarily be available in everyday care.

The interview group was mostly men with no interviewees younger than 39, so some perspectives were less well represented. Also, as they already had undetectable HIV, these findings cannot directly establish whether weekly treatment improves adherence among people struggling with daily medication.

While maintaining viral suppression remains essential, the study shows that the experience of doing so matters too.

References

Ramgopal M et al. Quality of life and treatment preference with weekly ISL/LEN versus standard of care: week 48 patient-reported outcome analysis of the phase 3 ISLEND-2 study. International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P057, 2026.

Orkin CM et al. Understanding treatment experiences with weekly oral islatravir/lenacapavir in the phase 3 ISLEND-2 study: participant and provider interviews. International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P056, 2026.

Colson AE et al. Switch to once-weekly, single-tablet islatravir-lenacapavir from daily standard of care for HIV-1 (ISLEND-2): a multicentre, randomised, open-label, active-controlled, phase 3 non-inferiority trial. The Lancet 408: 821–832, 2026.

doi: 10.1016/S0140-6736(26)01442-X