Today, HIV is not a death sentence - it’s a manageable condition
Twenty years ago, an HIV diagnosis meant a short life expectancy and constant fear. Today, someone diagnosed with HIV at age 30 can expect to live a near-normal lifespan. The reason? HIV treatment has changed completely. No longer do people need to swallow a handful of pills every day. New therapies let many people go months - even years - between doses. And it’s not just about survival anymore. People are living better, with less stress, fewer side effects, and more control over their lives.
How modern HIV treatment works
HIV attacks the immune system, specifically CD4 cells that fight infections. Left unchecked, it can lead to AIDS - a stage where the body can’t defend itself against common illnesses. But modern drugs stop HIV from multiplying. These drugs are grouped into classes based on how they block the virus:
- NRTIs and NNRTIs: Block the virus from copying its genetic material.
- Protease inhibitors: Stop the virus from assembling new copies of itself.
- Integrase inhibitors: Prevent HIV from inserting its DNA into human cells.
- Capsid inhibitors: Disrupt the virus’s protective shell - this is where the biggest breakthroughs are happening.
The most common single-pill regimen today is Biktarvy. It combines three drugs in one small tablet - just 459 mg, about the size of a pencil eraser. It’s taken once daily, works fast, and has fewer side effects than older pills. For people with kidney issues, DELSTRIGO is an alternative that’s gentler on the body.
The game-changer: Twice-yearly injections
In January 2025, something historic happened. The FDA gave Breakthrough Therapy Designation to a new combo called LTZ: lenacapavir (Sunlenca) plus two antibodies, teropavimab and zinlirvimab. This isn’t just another pill. It’s a twice-yearly injection. One shot in June, another in December. That’s it.
Early results from clinical trials show 98.7% of people on LTZ had no detectable virus after 48 weeks - better than daily pills. And the best part? People reported far less anxiety about forgetting doses. In one study, 89% of users felt completely confident in their adherence. For someone who spent 12 years worrying about missing a pill, that’s life-changing.
Lenacapavir works differently. Instead of targeting enzymes inside the cell, it attacks the virus’s outer shell - the capsid. This shell protects the virus’s genetic code. Break it, and the virus can’t replicate. A single injection keeps drug levels high for six months. That’s why it’s so powerful.
Prevention just got easier too
It’s not just for treatment. In June 2025, lenacapavir was approved for prevention under the name Yeztugo. If you’re at risk for HIV - whether through sex, needle sharing, or other exposure - you can now get a shot every six months instead of taking a daily pill like Truvada. The WHO called it “the next best thing to an HIV vaccine.”
Studies show it prevents over 99% of infections when used correctly. That’s better than daily oral PrEP. And for people who hate taking pills or forget them, this is a huge win. The catch? It needs to be given by a healthcare provider. You can’t pick it up at the pharmacy like a regular prescription.
Quality of life: More freedom, less stigma
Before long-acting treatments, many people hid their diagnosis. Taking pills every morning was a constant reminder - and sometimes, a target for judgment. One Reddit user wrote: “After 12 years of daily pills, the twice-yearly injection has eliminated my treatment-related anxiety completely.” That’s not an isolated story.
The Positive Peers app, used by over 150,000 people with HIV, found that 92% of those on long-acting regimens rated their satisfaction as 8 or higher out of 10. For people on daily pills? Only 76% did. The difference isn’t just medical - it’s emotional. Less daily reminders mean less internalized stigma. Less fear of being seen with a pill bottle. Less guilt when life gets busy.
Injection-site reactions - mild pain or swelling - happen in about 28% of cases. But 94% of users said it was worth it. A few days of soreness beats taking a pill every single day.
Cost and access: The biggest hurdle
Here’s the hard truth: these breakthroughs come with a high price tag. In the U.S., Biktarvy costs about $69,000 a year. Yeztugo is $45,000. That’s more than most people make in a year.
But there’s hope. UNAIDS and the European AIDS Treatment Group report that generic versions could be made for as little as $25 per person per year. That’s one-thousandth of the current price. If that happens, millions could get access - especially in Africa, Asia, and Latin America, where 70% of new HIV cases occur.
Right now, only 17% of U.S. clinics offered Sunlenca in early 2025 because it needs to be stored at -20°C. That’s freezer-level cold. After the Yeztugo approval, a more stable version came out. Now, 43% of clinics can offer it. In Europe, only 12% of patients use long-acting options. In sub-Saharan Africa? Less than 2%. The gap isn’t about science - it’s about money, infrastructure, and politics.
What’s next? The future of HIV care
By 2030, experts predict that 75% of people with HIV in wealthy countries will be on long-acting therapy. In poorer countries, that number could hit 40% - if the $25 generic version becomes real.
Gilead Sciences, the company behind lenacapavir, made $13.2 billion from HIV drugs in 2024. ViiV Healthcare, owned by GSK, made $4.7 billion. That’s a lot of profit. But if those profits are used to fund global access programs - not just shareholder dividends - the epidemic could end faster.
Right now, 1.3 million people got HIV in 2024. The global target was 370,000. We’re off track. But with better prevention tools like Yeztugo, and better treatment like LTZ, we have the tools. We just need the will.
What you need to know if you’re considering switching
If you’re on daily pills and thinking about switching to an injection:
- Ask your doctor if you’re a candidate. You need to have an undetectable viral load for at least six months.
- There’s a 4-week overlap period. You’ll still take your pills while starting the injection.
- Find a clinic that stocks the drug. Not every pharmacy or clinic carries it yet.
- Plan for the injections. You’ll need to come back every six months. Set reminders - programs with reminder systems see 96% on-time dosing.
- Be ready for mild soreness after the shot. Ice packs and ibuprofen help.
Providers need training too. Gilead found that 87% of doctors became confident after just three supervised injections. So if your clinic is new to this, ask for support. They’re learning too.
Final thoughts: Hope isn’t a luxury - it’s the new standard
HIV treatment has gone from survival to thriving. The science is no longer the bottleneck. The challenge now is making sure everyone benefits. The world has the tools to end HIV as a public health threat. We have pills that work. We have shots that last half a year. We have prevention that’s more effective than ever.
What’s missing isn’t innovation. It’s equity. If we can make these treatments affordable and accessible - not just in Melbourne or New York, but in Nairobi, Lagos, and Manila - then the next chapter of HIV won’t be about fear. It’ll be about freedom.
Can HIV be cured with today’s treatments?
No, current treatments don’t cure HIV. They suppress the virus to undetectable levels, which means it can’t be transmitted and the immune system can recover. But the virus still hides in reservoirs in the body. If you stop treatment, it comes back. Researchers are testing cure strategies - like combining antibodies with drugs that wake up hidden virus - but nothing is ready for widespread use yet.
Is long-acting HIV treatment safe for everyone?
Most people tolerate long-acting treatments well. But they’re not for everyone. You need to have an undetectable viral load before switching. People with severe kidney or liver disease may not be candidates. Also, if you have a history of injection-site infections or severe allergies to components in the drug, your doctor may advise against it. Always talk to your HIV specialist before switching.
How often do I need to get the injection?
For treatment, the LTZ combo (lenacapavir + antibodies) is given twice a year - every six months. For prevention (Yeztugo), it’s the same schedule. This is a huge change from daily pills or monthly injections like Apretude. You’ll need to plan ahead for clinic visits, but you won’t need to think about treatment the rest of the time.
Can I switch from daily pills to injections on my own?
No. Switching requires medical supervision. You must have an undetectable viral load for at least six months. Your doctor will run tests and likely have you overlap oral meds with the first injection for four weeks to make sure the virus stays suppressed. Never stop or change your meds without your provider’s guidance.
Are there any side effects from the injections?
The most common side effect is mild to moderate pain, redness, or swelling at the injection site. It usually lasts 2-3 days. About 12% of people report this in trials - less than with monthly shots. Serious reactions are rare. Ice packs and over-the-counter pain relievers like ibuprofen help. If swelling gets worse or you develop a fever, contact your clinic.
Will insurance cover long-acting HIV treatments?
In the U.S., most private insurers and Medicaid cover these treatments if you meet clinical criteria. Medicare Part D also covers them, but prior authorization is often required. In countries with universal healthcare, access varies. Australia, Canada, and the UK are starting to include them in national formularies. If you’re struggling with coverage, ask your clinic about patient assistance programs - many drugmakers offer them.
Can I still transmit HIV if I’m on long-acting treatment?
No - if your viral load is undetectable, you cannot transmit HIV through sex. This is called U=U (Undetectable = Untransmittable). It applies to all effective treatments, including long-acting ones. Studies confirm this for both oral and injectable regimens. But you still need to get your injections on time. Missing a dose can lead to viral rebound.
What’s the difference between Sunlenca and Yeztugo?
They’re the same drug - lenacapavir - but approved for different uses. Sunlenca is for treating HIV in people already infected. Yeztugo is for preventing HIV in people who are HIV-negative but at high risk. The dosage and schedule are the same: two injections six months apart. The difference is who gets it and why.
Tatiana Bandurina
20 Jan 2026 at 19:37The data looks good on paper, but let's not ignore that 83% of clinics in rural America still don't have the cold storage needed for these injections. This isn't progress-it's a luxury for the urban elite.