HIV treatment has been a daily pill for most people since the 1990s. That is changing. Long-acting injectable treatment is now available in South Africa, and the options are expanding.
What is available now
Cabenuva (cabotegravir + rilpivirine)
A monthly or two-monthly injection for people who are already virally suppressed on oral therapy. Cabenuva was approved in South Africa in 2024 and is being rolled out through selected clinics.
How it works: you get an intramuscular injection every one or two months. No daily pills. Adherence is essentially guaranteed as long as you keep your clinic appointments.
Who can use it: adults who are virologically suppressed (viral load under 50 copies) on their current regimen and have no history of treatment failure or resistance to the drugs in the injection.
Sunlenca (lenacapavir)
A six-monthly injection for people with multi-drug-resistant HIV. Lenacapavir was approved in South Africa in 2024 for treatment-experienced patients with limited options. It is also used as part of the new twice-yearly prevention injection (see our separate article on lenacapavir for prevention).
Who can use it: adults with multi-drug-resistant HIV whose current regimen is failing. It is not a first-line option.
What's coming
Weekly oral treatment
The ISLEND-1 Phase 3 trial reported positive results in July 2026 for a once-weekly oral regimen of islatravir and lenacapavir. If approved, it would offer a middle ground between daily pills and injections. Expect regulatory decisions in 2027 and South African availability in 2028 at the earliest.
Broadly neutralising antibodies (bNAbs)
A different class of long-acting treatment that uses antibodies instead of traditional antiretroviral drugs. bNAbs have shown promise in early trials but are not yet approved for treatment. They are more likely to be used for prevention first.
Other long-acting formulations
Several pharmaceutical companies are developing injectable and implantable formulations that could provide months or years of treatment per dose. These are earlier in development — expect 2030 or later.
Advantages of long-acting treatment
- No daily pill. Removes the daily reminder and the daily risk of discovery.
- Better adherence. Missing a clinic appointment is harder than missing a daily dose.
- Fewer side effects for some people. Injections bypass the digestive system, which can reduce gastrointestinal side effects.
- Privacy. No pill bottles at home.
Disadvantages
- Clinic visits. You have to go to a clinic every one or two months. That can be a barrier for people with work or transport issues.
- Injection-site reactions. Most people experience pain, redness, or swelling at the injection site, especially after the first dose.
- Limited options if treatment fails. If the virus becomes resistant while you are on a long-acting injectable, you have fewer options for what to switch to.
- Cost. Long-acting treatment is significantly more expensive than generic daily pills. Not all medical aids cover it, and public sector availability is limited.
Should you switch?
If you are doing well on your current daily treatment, there is no medical reason to switch. Long-acting treatment is an option, not an upgrade.
If daily pills are difficult for you — because of side effects, adherence, or privacy — it is worth discussing with your doctor. Long-acting treatment has changed the lives of many people who struggled with daily therapy.
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