Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
7.7
3.5
Journals
Viruses
Special Issues
Long-Acting Antiretrovirals
share announcement

Long-Acting Antiretrovirals

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: 31 August 2026 | Viewed by 5041

Special Issue Editors

Dr. Camilla Muccini

E-Mail Website
Guest Editor
Department of Infectious and Tropical Diseases, IRCCS—Ospedale San Raffaele, Via Stamira d'Ancona, 20, 20127 Milano, Italy
Interests: HIV; HIV-1 infection; antiretroviral therapy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Antonella Castagna

E-Mail Website
Guest Editor
Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
Interests: HIV; HIV-1 infection; antiretroviral therapy

Special Issue Information

Dear Colleagues,

In recent years, the landscape of antiretroviral therapy has been changed by long-acting antiretrovirals, which offer new paradigms for HIV prevention and treatment. These innovative therapies have the potential to significantly improve adherence and simplify regimens, moving away from the daily pill burden that has defined HIV treatment for decades.

The development and implementation of long-acting antiretrovirals also present unique challenges and opportunities. From novel pharmacokinetic profiles and dosing strategies to real-world considerations, such as equitable access and patient acceptability, long-acting antiretrovirals represent a pivotal point in HIV research and care. In addition, their potential use in both treatment and prevention raises important questions about their long-term efficacy, safety, and integration into existing healthcare systems.

This Special Issue aims to provide a comprehensive review of the current state and future directions of long-acting antiretroviral therapy. We invite researchers and clinicians to contribute original research articles, reviews, perspectives, and case studies on a wide range of topics, including (but not limited to) the following:

  • Clinical and pharmacological evidence on long-acting antiretrovirals.
  • Challenges and strategies for implementation in diverse populations.
  • Patient-centered perspectives on long-acting therapies.
  • Innovations in HIV prevention with long-acting agents.

Through this collection, we aim to highlight the potential of long-acting antiretrovirals and promote a deeper understanding of their role in both HIV treatment and prevention.

We look forward to your valuable contributions to this timely and exciting field.

Dr. Camilla Muccini
Prof. Dr. Antonella Castagna
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Viruses is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HIV infection
  • HIV prevention
  • long-acting
  • antiretroviral therapy
  • clinical studies

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Research

Jump to: Review

18 pages, 928 KB  
Article
Bridging the Gap: The PrEP Cascade Paradigm Shift for Long-Acting Injectable HIV Prevention
by Adrian Charles (AC) Demidont
Viruses 2026, 18(3), 336; https://doi.org/10.3390/v18030336 - 9 Mar 2026
Viewed by 691
Abstract
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) demonstrates superior efficacy and persistence compared to daily oral PrEP. However, real-world implementation reveals that only 52.9% of prescribed individuals initiate treatment with their first injection. This implementation barrier stems from a fundamental mismatch between the traditional [...] Read more.
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) demonstrates superior efficacy and persistence compared to daily oral PrEP. However, real-world implementation reveals that only 52.9% of prescribed individuals initiate treatment with their first injection. This implementation barrier stems from a fundamental mismatch between the traditional PrEP cascade—designed for oral formulations allowing same-day initiation—and LAI-PrEP’s unique requirements involving a 2–8 week “bridge period” between prescription and first injection to establish HIV-negative status. We synthesize data from major clinical trials (HPTN 083, HPTN 084, PURPOSE-1/2; >15,000 participants) with real-world implementation studies to characterize bridge period navigation as the critical implementation barrier. This review proposes a reconceptualized PrEP cascade explicitly recognizing the bridge period as a distinct, measurable step requiring dedicated management strategies. We examine pharmacological bases for conservative initiation protocols, quantify population-specific barriers to bridge period completion, and synthesize evidence on strategies to improve initiation success. This paradigm shift from individual behavioral adherence to structural factors within the healthcare system requires parallel innovations in cascade conceptualization, measurement frameworks, and implementation approaches. Addressing this structural barrier is essential to translate LAI-PrEP’s extraordinary clinical efficacy (>96%) into meaningful public health impact, particularly for populations experiencing the highest HIV burden. Full article
(This article belongs to the Special Issue Long-Acting Antiretrovirals)
►▼ Show Figures

Figure 1

20 pages, 3750 KB  
Article
Computational Validation of a Clinical Decision Support Algorithm for LAI-PrEP Bridge Period Navigation at UNAIDS PrEP Target Scale (21.2 Million Individuals)
by Adrian Charles Demidont
Viruses 2026, 18(2), 237; https://doi.org/10.3390/v18020237 - 13 Feb 2026
Cited by 1 | Viewed by 711
Abstract
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) demonstrates superior efficacy to oral PrEP but faces a critical implementation challenge: 47% of patients fail to receive their first injection during the “bridge period” between prescription and initiation. We developed a clinical decision support tool with [...] Read more.
Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) demonstrates superior efficacy to oral PrEP but faces a critical implementation challenge: 47% of patients fail to receive their first injection during the “bridge period” between prescription and initiation. We developed a clinical decision support tool with an external configuration architecture synthesizing evidence from major LAI-PrEP trials (HPTN 083, HPTN 084, PURPOSE) and implementation studies. The tool provides population-specific risk stratification, barrier identification, and evidence-based intervention recommendations from a library of 21 interventions with mechanism diversity scoring to prevent redundant recommendations. We conducted progressive validation on four scales: 1000 (functional), 1,000,000 (large-scale), 10,000,000 (ultra-large-scale) and 21,200,000 patients (UNAIDS PrEP target), with comprehensive unit testing achieving a test pass rate of 100% (18/18 edge cases). Progressive validation demonstrated convergence and increasing precision: 1K (±2.6 pp), 1M (±0.09 pp), 10M (±0.028 pp), and 21.2M (±0.018 pp). At UNAIDS 2025 PrEP target (21.2 million) scale, the tool predicted baseline bridge period success rate of 23.96% (95% CI: 23.94–23.98%), with evidence-based interventions improving success to 43.50% (95% CI: 43.48–43.52%)—an absolute improvement of 19.54 pp (or 81.6% relative improvement), representing 4.1 million additional successful transitions globally. Population disparities were substantial: People who inject drugs (PWID) showed 10.36% baseline success versus 33.11% for men who have sex with men (MSM)—a 22.75 pp gap. Regional disparities were equally significant: Sub-Saharan Africa (serving 62% of global patients) achieved 21.69% baseline versus 29.33% in Europe/Central Asia—a 7.64 pp gap. However, evidence-based interventions disproportionately benefited vulnerable populations. PWID experienced +265% relative improvement, and adolescents experienced +147% relative improvement, demonstrating that systematic implementation support can narrow rather than widen health equity gaps at UNAIDS 2025 PrEP target (21.2 million) scale. The tool demonstrates predictive validity with policy-grade statistical precision. Using published epidemiologic parameters (HIV incidence 2–5% among indicated users, LAI-PrEP efficacy 96%), our model translates the 4.1 million additional successful transitions into approximately 80,000–100,000 prevented HIV infections annually (midpoint: 100,000), corresponding to an estimated USD 40 billion in averted lifetime treatment costs. Full article
(This article belongs to the Special Issue Long-Acting Antiretrovirals)
►▼ Show Figures

Graphical abstract

Review

Jump to: Research

15 pages, 453 KB  
Review
Safety, Tolerability, and Metabolic Effects of Long-Acting Cabotegravir and Rilpivirine in HIV Care: A Comprehensive Review
by Martina Bottanelli, Antonella Castagna and Camilla Muccini
Viruses 2025, 17(8), 1108; https://doi.org/10.3390/v17081108 - 12 Aug 2025
Cited by 4 | Viewed by 2909
Abstract
The use of long-acting cabotegravir and rilpivirine (LA CAB/RPV) is a novel approach to manage human immunodeficiency virus (HIV). This injectable regimen offers benefits such as an improved quality of life, reduced stigma and enhanced treatment satisfaction by minimising the need for daily [...] Read more.
The use of long-acting cabotegravir and rilpivirine (LA CAB/RPV) is a novel approach to manage human immunodeficiency virus (HIV). This injectable regimen offers benefits such as an improved quality of life, reduced stigma and enhanced treatment satisfaction by minimising the need for daily medication adherence. This review summarises the findings of clinical trials and real-world studies on the safety, tolerability and metabolic effects of LA CAB/RPV, which are areas that have received less extensive coverage in previous reviews. Clinical trial data suggest that LA CAB/RPV is generally safe and well tolerated. The most common side effects were injection site reactions, affecting 70–97% of participants. However, these were typically mild and short lived, rarely leading to treatment discontinuation in fewer than 2–3% of cases. Systemic side effects were minimal and comparable to those observed with traditional oral antiretroviral therapy. Real-world studies corroborated these findings, reporting low discontinuation rates due to adverse events. Regarding metabolic impact, clinical trials showed minimal weight gain (an average increase of 1–2 kg over 48–96 weeks) with no significant differences or impact on lipid and glucose levels. Although real-world data are still emerging, they suggest similar trends, including a possible improvement in lipid profiles. Overall, LA CAB/RPV appears to be a safe, well-tolerated and effective treatment option, although longer-term follow-up is needed. Full article
(This article belongs to the Special Issue Long-Acting Antiretrovirals)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-3
Back to TopTop