Pharmacological advances in HIV treatment: from ART to long-acting injectable therapies

Human immunodeficiency virus (HIV) remains a global public health challenge, affecting millions worldwide despite significant advancements in antiretroviral therapy (ART). While ART has transformed HIV into a manageable chronic condition, long-term adherence, drug resistance, and access disparities continue to hinder treatment success. Recent research has focused on developing alternative therapeutic strategies, particularly long-acting injectable (LAI) therapies and immunotherapeutic approaches to improve adherence and potentially achieve viral remission. This review explores the evolution of pharmacological advancements in HIV treatment, highlighting the transition from daily oral ART to long-acting formulations such as cabotegravir, rilpivirine, and lenacapavir. LAI therapies reduce the burden of daily adherence, enhance treatment efficacy, and decrease stigma, particularly in vulnerable populations. Additionally, novel immunotherapeutic strategies such as broadly neutralizing antibodies, immune checkpoint inhibitors, and chimeric antigen receptor T cell therapy are being investigated for their potential to induce long-term viral suppression or cure. Despite these promising developments, several challenges remain, including resistance-associated mutations, accessibility issues, and long-term safety concerns. This review summarizes recent clinical trials, discusses the benefits and limitations of emerging HIV therapies, and outlines future research directions. The continued advancement of LAI therapies and immunotherapeutics holds great potential to improve treatment outcomes, expand global access to care, and move closer to a functional cure for HIV.