Integrative Biomedical Research
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN 3068-6326
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Articles
Volume 10 Number 2 2026
REVIEWS (Open Access)
Long-Acting Injectable Antiretrovirals Improve HIV Outcomes but Expose Gaps in Health System Readiness
Mst Murshida Mahbub 1*, Itishree Jogamaya Das 2, Himansu Bhusan Samal 3
Integrative Biomedical Research 10 (2) 1-8 https://doi.org/10.25163/biomedical.10210947
Submitted: 29 January 2026 Revised: 15 March 2026 Accepted: 25 March 2026 Published: 27 March 2026
Abstract
For nearly three decades, adherence to antiretroviral therapy has meant one thing above all: taking a pill, every single day, without fail. That expectation, reasonable as it once seemed, has proven quietly punishing for a great many people living with HIV (PLWH), whose lives are shaped by stigma, unstable circumstances, or simply the accumulated fatigue of managing a lifelong illness. This narrative review traces how long-acting injectable antiretroviral therapy (LAI-ART) is beginning to loosen that grip. Drawing on Phase 3 trials, real-world cohorts, and implementation-science literature, we synthesize evidence across five interconnected domains: neuroimmune and central nervous system complications, cardiometabolic and morphological change, syndemic co-infections, socio-behavioral and structural vulnerability, and the long-acting therapeutic paradigm itself. Cabotegravir plus rilpivirine, dosed monthly or bimonthly, and lenacapavir, dosed twice yearly, now deliver virological outcomes non-inferior to daily oral regimens, while sparing patients the psychological weight of daily reminders and disclosure anxiety. Injection-site reactions are common but rarely treatment-limiting, and metabolic profiles — particularly HDL-cholesterol — appear to improve after switching. Yet the promise is not unconditional. A pharmacokinetic “tail” persists for months after a missed dose, eligibility rules still exclude many non-suppressed patients who might benefit most, and cold-chain logistics, staffing shortages, and inconsistent insurance coverage remain genuine obstacles, particularly for incarcerated individuals, people who inject drugs, and communities in co-endemic or low-resource settings. We argue, ultimately, that realizing the full potential of long-acting antiretrovirals will depend less on pharmacology than on whether health systems can be rebuilt around it — equitably, and with an honest eye toward the syndemic realities patients actually live with.
Keywords: long-acting injectable antiretroviral therapy; cabotegravir; rilpivirine; lenacapavir; HIV chronic disease management; adherence; implementation science
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