Islamabad: A combination of two long-acting HIV injections kept the virus suppressed in 46 US patients for nearly two years, including those with drug resistance, but the regimen is unapproved and Pakistan, with thousands outside care, faces steep hurdles.
The study by the University of California, San Francisco (UCSF), published in JAMA Network Open on Oct 8, tested lenacapavir with cabotegravir. Lenacapavir targets the HIV capsid, the protective shell around the virus’s genetic material, and is given as an injection every six months.
Cabotegravir is an integrase inhibitor that stops the virus from integrating into human cells, and also comes in a long-acting injectable form.
Patients, including men, women and people of different gender identities, were treated at San Francisco’s Ward 86 HIV clinic between March 2023 and May 2025, and their outcomes were assessed through November 2025.
Of the 46 patients (median age 47), 24 had viral loads of at least 200 copies per millilitre when treatment began, while 22 were already suppressed. All 24 with elevated loads fell below 200 within 13 weeks, and the rest stayed suppressed. Over a median follow-up of 100 weeks, about one year and 11 months, no patient had confirmed virological failure, defined as two consecutive readings above 200.
Thirty-three patients (72 per cent) had resistance to at least one class of existing drugs, and four to integrase inhibitors. Nineteen had unstable housing, and others struggled with substance use, circumstances that make daily pills hard to take. Injections reduce that burden, though patients must still attend appointments and monitoring. Injection-site reactions affected 27 patients and nodules 18.
Senior author Dr Monica Gandhi said it was the largest case series of this combination to date. The authors, however, warned that the study was small, single-centre and observational, with no control group on conventional treatment. It cannot show the pair is better than existing regimens. Although both drugs have established uses in HIV treatment or prevention, the two-drug combination remains investigational and unapproved. Two clinical trials are planned.
The findings matter for Pakistan, where infections are rising and many people remain undiagnosed, unregistered or out of treatment. Officials told the National Assembly Standing Committee on National Health Services in May that about 369,000 people were estimated to live with HIV, but only 84,000 were registered with treatment services. About 14,000 new cases were reported in 2025, and around 20,000 registered patients started therapy but lost contact with services, raising fears of disease progression and continued transmission.
Free antiretroviral medicines are provided at designated public-sector centres with support from partners including the Global Fund, while the UNDP backs the response through Global Fund-funded programmes covering medicines and diagnostics. Late diagnosis, stigma, long distances to clinics, difficulty sticking to daily doses and weak follow-up remain obstacles.
Long-acting injections could help patients who cannot take daily pills, provided their effectiveness, safety, affordability and suitability for local conditions are established. Introducing this combination would need regulatory approval, reliable supplies, resistance testing, trained health workers and systems to ensure patients return on schedule. Cost could burden a publicly funded programme already under strain.
Guidelines stress that effective therapy can suppress HIV to undetectable levels, allowing long, healthy lives. But suppression does not mean the virus is gone, and treatment must continue.
For Pakistan, the study highlights the need for more flexible, patient-friendly care, alongside stronger diagnosis, retention and follow-up.
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