The HIV treatment landscape is changing fast. Research presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver pointed towards a future of fewer pills, less frequent dosing and new drug classes – from twice-yearly injectables to a simplified regimen for people on complex treatment. Here are five highlights.
Three experimental injectable antiretrovirals – a novel capsid inhibitor (VH-499) and two next-generation integrase inhibitors (VH-184 and GS-3242) – showed pharmacokinetic profiles that could support dosing just twice a year. All three drugs were safe and well tolerated in early human trials. These agents could eventually be combined with broadly neutralising antibodies or other long-acting drugs to create complete regimens requiring only two or three clinic visits a year – a prospect that would have seemed far-fetched a few years ago.
A broadly neutralising antibody called lotivibart (N6LS), given by intravenous infusion every four months alongside monthly cabotegravir injections, maintained viral suppression in 94% of participants at one year. The infusion formulation was better tolerated than a subcutaneous injection version and has been selected for further development. The researchers are now testing lotivibart infusions every six months plus cabotegravir every other month.
A once-daily combination pill containing bictegravir and lenacapavir could simplify treatment for people currently taking complex regimens. While many people with HIV today can take a single daily pill, some people who were diagnosed in the earlier years of the epidemic are still taking multiple tablets, sometimes twice daily, often including boosted protease inhibitors which can interact with other medications. In a phase III trial, people who switched from these complex regimens to a single bictegravir and lenacapavir tablet maintained viral suppression at 48 weeks (96.0%, compared with 93.5% who stayed on their existing regimen). A second trial showed comparable results when people switched from a standard three-drug regimen. Gilead plans to submit the results to drug regulators soon.
A two-drug combination of doravirine and islatravir proved non-inferior to the three-drug combination of bictegravir, emtricitabine and tenofovir alafenamide (Biktarvy) as first-line treatment. At 48 weeks, viral suppression rates were near-identical (91.8% vs 90.6%). Islatravir is the first nucleoside reverse transcriptase translocation inhibitor (NRTTI), a new drug class, and its pairing with the NNRTI doravirine creates an integrase-inhibitor-free regimen that could be an option for people who need to avoid integrase inhibitors.
Our round-up of paediatric studies includes promising data on injectable cabotegravir/rilpivirine in adolescents. The IMPAACT 2017 study showed that two years of two-monthly injections safely maintained viral suppression in teenagers living with HIV – a group that often struggles with adherence to daily pills.
