Adolescents living with HIV who switched to an injection every eight weeks were less likely to see the virus return than those who stayed on daily tablets, according to a large trial published in The Lancet. The catch is that the injectable is hardly available where most young people with HIV live.

The LATA trial, led by University College London (UCL), enrolled 476 adolescents aged 12 to 19 at five clinics in Kenya, South Africa, Uganda and Zimbabwe. All had been on tablets for more than a year, had fully suppressed HIV and had no earlier treatment failure. Almost all had been born with HIV. They were randomly assigned to keep taking daily tablets or to switch to injections of cabotegravir and rilpivirine every eight weeks.

After 96 weeks, confirmed viral rebound had occurred in two adolescents (1%) in the injection group and 15 (6%) in the tablet group, UCL said. In the injection group, 94% said eight-weekly dosing was much easier than daily medication.

“HIV-positive adolescents as a group have historically done worse on antiretrovirals compared to adults,” chief investigator Prof. Sarah Pett of UCL said, according to ANI. “Long-acting injectables taken every two months can help young people to lead a more normal life.”

Drug Topics, summarising the paper, reports that the trial was designed to test whether injections were no worse than tablets, and that they met that bar and also showed an advantage. It puts serious adverse events at 14 in the injection group and 12 on tablets, with injection-site reactions in 91% of those on injectables, generally mild. We have not seen the paper, so these figures should be checked against it.

The access gap is the main concern. About nine in ten adolescents with HIV live in Africa, yet injectables are available in only a few clinics there, UCL noted. They cost more because the drugs are still under patent, rilpivirine must be refrigerated, and trained nurses are needed to give the shots. No generic version has been agreed. “The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care,” said corresponding author Dr. Deborah Ford.

The results apply to adolescents who were already virally suppressed and had no earlier treatment failure, not to those starting treatment or struggling with it. The trial was open-label, so participants knew which treatment they had, and the number of rebound cases is small. The World Health Organization recommends long-acting injectables as an “alternative” for some adults and adolescents who are suppressed and do not have active hepatitis B.

The trial was funded by the European Union through EDCTP-2 and Johnson & Johnson Innovative Medicines, which supplied rilpivirine. ViiV Healthcare supplied cabotegravir. UCL was the sponsor.