Thirty years ago, an HIV diagnosis meant a death sentence. Today, it’s a chronic condition - one that can be managed with a single injection every six months. The science has changed. The expectations have changed. And for millions of people living with HIV, so has their daily reality.
From Daily Pills to Twice-Yearly Injections
The old routine was brutal: wake up, swallow a handful of pills, do it again at night, every single day, for life. Miss one dose, and the virus could bounce back. Fear of stigma, memory lapses, side effects - it all added up to mental exhaustion. Now, there’s another way.Lenacapavir, branded as Sunlenca for treatment and Yeztugo for prevention, is the first HIV medication that works for six months after just one shot under the skin. Approved in late 2022 for treatment and in mid-2025 for prevention, it’s part of a new class of drugs called capsid inhibitors. Unlike older drugs that block enzymes, lenacapavir physically traps the virus by disrupting its protective shell - the capsid - stopping it from copying itself inside your cells.
By early 2025, researchers added two powerful antibodies - teropavimab and zinlirvimab - to create the LTZ regimen. In clinical trials, this combo kept the virus undetectable in 98.7% of patients after 48 weeks. That’s better than daily pills. And the best part? You only need two shots a year.
How Today’s Top HIV Drugs Compare
Not everyone is ready for injections. For many, daily pills still work perfectly. Here’s what’s on the market now:
| Drug Name | Type | Dosing | Key Benefit | Limitation |
|---|---|---|---|---|
| Biktarvy | INSTI + NRTI combo | Once daily, one pill | Smallest tablet available (459 mg); no food restrictions | Requires daily adherence; kidney monitoring needed |
| DELSTRIGO | NNRTI + NRTI combo | Once daily, one pill | Safe for people with mild kidney issues | Not for those with hepatitis B co-infection |
| Sunlenca (lenacapavir) | Capsid inhibitor | Every 6 months (after initial doses) | 98%+ viral suppression; eliminates daily pill stress | Must be administered by a clinician; cold storage required |
| Yeztugo (lenacapavir for PrEP) | Capsid inhibitor | Every 6 months | 99% effective at preventing HIV in high-risk groups | Costs $45,000/year list price; generics may drop to $25 |
| DOR/ISL (investigational) | Two-drug daily | Once daily | Potentially safer for heart health | Still in trials; not yet approved |
For most people starting treatment today, doctors recommend Biktarvy or a similar single-tablet regimen - simple, effective, and well-tolerated. But for those struggling with daily pills, the shift to lenacapavir is life-changing.
Quality of Life: More Than Just Viral Suppression
Being undetectable isn’t just about health numbers. It’s about peace of mind.
A 2025 survey of 150,000 people with HIV using the Positive Peers app found that 92% of those on long-acting treatments rated their satisfaction at 8 out of 10 or higher. Only 76% of people on daily pills felt the same. Why? Because the burden of remembering pills every day - the guilt when you forget, the fear of disclosure, the anxiety of running out - is gone.
On Reddit, one user wrote: “After 12 years of daily pills, the twice-yearly injection has eliminated my treatment-related anxiety completely.” That’s not an outlier. In trials, 89% of people on LTZ reported high confidence in their adherence. For daily regimens? Just 63%.
Injection-site reactions - mild pain, swelling - happen in about 28% of users. But 94% of those same people said it’s still worth it. “I’d rather have soreness for two days than think about pills every morning,” said one participant.
Access and Cost: The Big Hurdle
Here’s the uncomfortable truth: these breakthroughs are expensive.
Biktarvy costs about $69,000 a year in the U.S. Yeztugo, the prevention version, is listed at $45,000. But here’s the twist: generic versions could be produced for as little as $25 per person per year. That’s not science fiction - it’s the projected cost if manufacturers scale up production, as outlined in a 2025 report by the European AIDS Treatment Group.
Right now, only 17% of U.S. clinics offered Sunlenca in early 2025 because it needs to be stored at -20°C. That’s a freezer-level requirement, not something most local pharmacies can handle. After Yeztugo’s approval, manufacturers improved the formulation. Now, 43% of clinics can offer it. Still, in sub-Saharan Africa, less than 2% of people with HIV have access to long-acting treatments.
The World Health Organization knows this. In July 2025, they issued new guidelines urging countries to train community health workers to administer these injections - not just doctors or nurses. That’s the only way this progress reaches the people who need it most.
What’s Next? The Future of HIV Care
The next big milestone? Full approval of the LTZ regimen (lenacapavir + two antibodies) by mid-2026. If it gets approved, it could become the new gold standard for both treatment and prevention.
Researchers are also testing whether combining these long-acting drugs with other therapies might actually cure HIV - not just control it. Early results are cautious but promising. Three out of 25 participants in a recent trial stayed virus-free after stopping all treatment. It’s not a cure yet, but it’s a sign we’re moving closer.
By 2030, experts predict 75% of people with HIV in high-income countries will be on long-acting regimens. In low-income countries? That number could hit 40% - if pricing drops and delivery systems improve.
The real question isn’t whether these treatments work. They do - better than ever. The question is: who gets to use them?
What You Need to Know If You’re Considering a Switch
If you’re on daily pills and thinking about switching to an injection:
- You’ll need to overlap oral meds for about 4 weeks while your body adjusts to the injection.
- Your provider will need to be trained - not all clinics offer this yet.
- Check your insurance. Some plans cover long-acting therapies fully; others require prior authorization.
- Don’t panic if you miss an appointment. These drugs stay in your system for months. But schedule your next one as soon as you can.
- Side effects? Most are mild: soreness at the injection site, headache, or fatigue for a day or two. Ice and ibuprofen help.
And if you’re HIV-negative but at risk? Yeztugo is now an option. It’s not a vaccine, but it’s the closest thing we have right now - and it’s more effective than daily PrEP pills.
Why This Matters Beyond the Individual
When someone with HIV is undetectable, they can’t transmit the virus. That’s not theory - it’s fact, backed by decades of data. So when more people use long-acting treatments, transmission drops.
Science Magazine estimates that if lenacapavir-based regimens were rolled out globally, HIV transmission could fall by up to 65%. That’s not just a medical win - it’s a public health revolution.
But without fair pricing, this revolution will leave millions behind. As UNAIDS put it: “Without urgent action on pricing, these breakthroughs will remain out of reach for the majority of people who need them.”
The tools are here. The science is proven. The question now is whether society will choose equity over profit.
Can you still get AIDS if you’re on modern HIV treatment?
No. AIDS is the late stage of untreated HIV. Modern treatments, especially long-acting ones like lenacapavir, prevent the virus from damaging the immune system. If you take your treatment as prescribed and stay undetectable, you won’t progress to AIDS - ever.
Are long-acting HIV treatments safe for everyone?
Most people tolerate them well. But they’re not for everyone. If you have severe liver disease, certain allergies, or are pregnant, your doctor will check if it’s right for you. People with kidney issues may need to avoid some oral regimens, but lenacapavir doesn’t rely on kidney function - making it a good option for many with renal concerns.
How do I know if I’m eligible for lenacapavir?
If you’re newly diagnosed and want to avoid daily pills, or if you’ve struggled with adherence on oral meds, you’re likely a candidate. Your HIV specialist will test your virus strain to make sure it’s not resistant to capsid inhibitors. For prevention (Yeztugo), you must be HIV-negative and at higher risk - such as having unprotected sex with multiple partners or sharing needles.
Can I switch from Biktarvy to Sunlenca?
Yes. Many people do. Your provider will have you continue Biktarvy for about 4 weeks while starting the first lenacapavir injection. This ensures your virus stays suppressed while your body builds up the long-acting drug. After that, you’ll get your next injection in six months.
What if I can’t afford these new treatments?
Many countries offer patient assistance programs. In the U.S., Gilead has a co-pay assistance program that can reduce your cost to $0. Outside the U.S., UNAIDS and global health groups are pushing for generic versions to be made available at $25 per year - a price point that could make these drugs accessible in low-income regions. Ask your clinic about financial aid options.
Do these treatments cure HIV?
Not yet. But they do something even more powerful: they make HIV a non-issue in daily life. You can live as long as someone without HIV, have children, have sex without risk of transmission, and live without fear. A cure is still being researched, but for now, control is the real victory.
What’s Next for You?
If you’re living with HIV, talk to your provider about whether long-acting options are right for you. If you’re HIV-negative and at risk, ask about Yeztugo. If you’re a caregiver or advocate, push for better access in your community.
The tools to end the HIV epidemic are here. The question is no longer whether we can - but whether we will.