Infectious Disease · Medical Literature
[Correspondence] A new era of hope: the impact of long-acting injectables for individuals ageing with childhood HIV
Abstract
HIV carries an unwarranted stigma especially in perinatal and prepubescent populations.1 Thanks to the introduction of antiretroviral therapy (ART) during pregnancy, the rate of perinatal HIV transmission has decreased from 20–30% to 0·1–0·5%.2,3 In 2022, nearly 13 000 people in the US were living with perinatal HIV;4 these patients cannot be forgotten. For this perinatal population, daily medication is both beneficial and emotionally challenging. Daily medication can feel burdensome and overwhelming, leading to non-compliance or discontinuation; risking resistance, viraemia, mental anguish, and resentment.
Clinical relevance
Can long-acting injectable antiretroviral therapy (LAI-ART) address the unique adherence burden and psychosocial challenges faced by individuals ageing with perinatally acquired HIV? __SNAPSHOT__ {"studyDesign":"Correspondence (expert opinion / narrative commentary); not an original research study or systematic review","setting":"Not reported; no specific clinical site or country identified","sampleSize":"Not applicable (no study population enrolled; correspondence format)","population":"Individuals living with perinatally acquired HIV, including those who acquired HIV as neonates or children and are now ageing into adolescence and adulthood; approximately 13,000 such individuals estimated to reside in the US as of 2022","intervention":"Long-acting injectable antiretroviral therapy (LAI-ART) as an alternative to daily oral ART in the perinatal HIV population","comparator":"Daily oral antiretroviral therapy (standard of care); no formal comparator group in this correspondence","primaryOutcome":"Not applicable; this is an opinion piece. The correspondence addresses the potential impact of LAI-ART on adherence, quality of life, stigma, mental health, and virologic outcomes in perinatally HIV-infected individuals","followUp":"Not applicable","fundingSource":"Not reported"}
Key findings
No original quantitative data are presented in this correspondence. The authors contextualize their argument using the following cited figures: the rate of perinatal HIV transmission has declined from 20–30% to 0.1–0.5% following the introduction of maternal ART; approximately 13,000 individuals in the US were living with perinatal HIV as of 2022. The authors argue that daily oral ART is associated with emotional burden and non-adherence in this population, which may lead to viremia, drug resistance, and psychological harm. No effect sizes, confidence intervals, p-values, or NNT/NNH are reported in the abstract. Relevant contemporaneous data from other sources provide context: the LATA randomized trial (AIDS 2026) found that among 476 virologically suppressed adolescents aged 12–19 years randomized to long-acting cabotegravir/rilpivirine (Cabenuva, every 8 weeks) versus daily oral dolutegravir/tenofovir disoproxil fumarate/lamivudine, confirmed viral rebound occurred in 2 patients in the injectable arm versus 15 in the oral arm over 96 weeks (absolute and relative effect sizes not calculable from available abstract data); acceptability strongly favored the injectable option. The US Pediatric HIV/AIDS Cohort Study (PHACS) demonstrated that non-adherence in perinatally HIV-infected youth increased from 31% to 50% (p<0.001) and unsuppressed viral loads increased from 16% to 40% (p<0.001) between preadolescence and late adolescence/young adulthood (sourced from NIH guidelines, not from this correspondence).
Practice implications
This correspondence establishes an important advocacy position—that perinatally HIV-infected individuals ageing into adulthood represent a neglected but clinically vulnerable population for whom LAI-ART may offer substantial benefit through reduced adherence burden, mitigation of stigma, and improved virologic outcomes. What it does not establish, however, is any causal or statistically demonstrated benefit of LAI-ART specifically in this population, as no original data are presented. The abstract neither defines inclusion/exclusion criteria nor presents outcomes. The argument is based on a combination of epidemiologic statistics and clinical reasoning, not primary evidence. The perinatal HIV population faces compounded challenges including disclosure issues, caregiver transitions, mental health comorbidities, and social stigma—factors that daily pill burden may exacerbate. Findings from contemporaneous trials (e.g., LATA) in virologically suppressed adolescents provide indirect empirical support, but those trials were not exclusively in perinatal populations, and none were conducted primarily in US or high-income settings. Applicability of existing LAI-ART data to those with long-standing treatment experience, complex resistance patterns, or very young age (pre-adolescent) remains uncertain. This summary is based solely on the published abstract and correspondence text; full-text review may reveal additional nuance or cited evidence. Clinical practice decisions should not be based on this correspondence alone. __LIMITATIONS__ 1. Study design: This is a correspondence (opinion letter), the lowest tier of clinical evidence; no original data are collected, analyzed, or reported. 2. No quantitative outcomes: Effect sizes, confidence intervals, p-values, and patient-level data are entirely absent. 3. Population specificity: No systematic characterization of the perinatal HIV population is performed; clinical heterogeneity (e.g., age range, ART history, resistance profile, geographic context) is unaddressed. 4. Selection bias: The arguments may not account for perinatally infected individuals who are well-adherent on daily oral therapy and for whom LAI-ART may offer marginal additional benefit or introduce new risks. 5. Generalizability: The US-centric epidemiologic figures cited (13,000 individuals living with perinatal HIV) may not reflect global burden, and implementation barriers in low- and middle-income countries—where the majority of perinatally infected individuals reside—are not addressed. 6. LAI-ART eligibility constraints: Current approvals for cabotegravir/rilpivirine require viral suppression and the absence of resistance-associated mutations to relevant drug classes; individuals with prior virologic failure or archived resistance (common in long-treated perinatal cohorts) may not qualify. 7. Funding and conflict of interest: Not reported. 8. No peer-reviewed data presented: No citations from within the abstract can be independently evaluated for quality. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This Lancet Infectious Diseases correspondence argues that LAI-ART represents a clinically meaningful opportunity to address the adherence burden, stigma, and psychosocial challenges unique to individuals ageing with perinatally acquired HIV—a population of approximately 13,000 in the US alone. While the advocacy is timely and contextually coherent with emerging RCT data from adolescent populations (e.g., LATA trial), this piece presents no original data and cannot independently inform practice change. Clinicians should consider LAI-ART for virologically suppressed, resistance-eligible perinatal HIV patients where adherence or psychosocial burden is a concern, guided by emerging guideline updates and patient-centered shared decision-making.