Evolving HIV treatment strategies… new treatment options emerge

‘Dovato,’ a two-drug regimen that reduces drug burden…establishes itself as an initial treatment option

‘Vocabria + Rekambys,’ administered once every two months, draws attention as a new option

The paradigm of HIV treatment is expanding beyond simple viral suppression toward a “lifecycle management” strategy that considers the entire lifespan of people living with HIV.

Within the current HIV treatment landscape, a variety of options have emerged, ranging from oral dual-drug regimens that reduce the medication burden during the initial treatment phase to long-acting injectables that prioritize quality of life during long-term treatment. Consequently, treatment strategies are becoming increasingly multifaceted.

HIV had long been perceived as a fatal infectious disease characterized by rapid disease progression and high mortality. However, with advances in antiretroviral therapy (ART), the life expectancy of people living with HIV has increased to approximately 78 years, reaching a level not significantly different from that of the general population.

At the same time, the U=U (Undetectable = Untransmittable) concept—which states that the virus cannot be transmitted to others once the viral load in the blood becomes undetectable— has positioned HIV treatment as a core pillar of public health strategy, moving beyond individual care.

Accordingly, HIV treatment is shifting from a question of survival to ‘how to manage the disease for a long time and in good health.’ In actual clinical practice, the number of patients newly diagnosed in their 20s and 30s is increasing, alongside those in their 60s and 70s who have been on treatment for decades, underscoring the growing importance of long-term treatment management strategies.

Amid these changes, there is an emphasis on an approach that considers the entire treatment journey, from the initial treatment phase through long-term management. Among the leading treatment options are GSK’s oral two-drug regimen ‘Dovato (dolutegravir and lamivudine)’ and the combination therapy of the long-acting injectable combination therapy ‘Vocabria (cabotegravir) + Rekambys (rilpivirine).’

Two-drug regimen ‘Dovato’ emerges as an initial treatment strategy…effective viral suppression with minimal drug burden

HIV treatment drug ’Dovato.’

More than half (approximately 66.7%) of newly diagnosed HIV infections in Korea are diagnosed in people in their 20s and 30s. Since lifelong treatment is required from the time of diagnosis, the importance of strategies to minimize the medication burden during the initial treatment stage is increasing.

Dovato, a two-drug oral regimen, is characterized by its ability to reduce drug exposure while demonstrating viral suppression efficacy non-inferior to existing three-drug regimens.

In the GEMINI I and II studies, Dovato demonstrated non-inferiority in viral suppression compared with the dolutegravir (DTG) + tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)-based three-drug regimen, and the TANGO study reported positive results regarding bone and renal biomarkers and lipid changes compared to TAF-based therapy. The risk of weight gain was also found to be relatively lower.

Thermore, the PASO-DOBLE study, which directly compared the regimen to the existing three-drug regimen of bictegravir (BIC), FTC, and TAF, confirmed non-inferiority in viral suppression rates at week 48, and reported relatively lower risks of weight gain and metabolic side effects.

The DOLCE study, conducted in a high-risk group of treatment-naïve HIV-infected individuals with low CD4 counts and high viral loads, and the ATTEND study, which focused on late-diagnosed individuals, also confirmed similar viral suppression effects compared to triple therapy.

Based on these study results, guidelines from the Spanish AIDS Research Group GeSIDA (Grupo de Estudio de SIDA), as well as those in Norway, Sweden, and other countries, recommend Dovato as an initial treatment option regardless of baseline viral load.

Every 2 month injectable better utilized for HIV in the long term…offers greater utilization in long-term treatment stages

HIV treatment drugs ‘Vocabria’ and ‘Rekambys’

As HIV treatment enters the long-term management phase, the focus of treatment has naturally shifted toward quality-of-life management.

Amid this trend, the long-acting injectable combination therapy ‘Vocabria + Rekambys,’ administered once every two months, is also establishing itself as a major treatment option.

In the Phase III SOLAR study, the therapy demonstrated non-inferiority in both virologic failure rates and viral suppression rates compared with the standard three-drug oral regimen (BIC/FTC/TAF).

Treatment satisfaction was also high. The study found that approximately 90% of patients who switched to the long-acting injectable regimen preferred it over the existing oral regimen, citing the following main reasons: ▲ the absence of the need to take medication daily, ▲ treatment convenience, and ▲ reduced psychological burden from being repeatedly reminded of their HIV status through daily medication.

The U.S. Department of Health and Human Services (DHHS) guidelines also state that switching to long-acting injectable therapies can improve treatment convenience and reduce medication-related fatigue and the burden of social stigma.

In the CARES study, which reflects real-world clinical practice, the virologic success rate of the long-acting injectable therapy reached 96.9%, showing similar efficacy to the oral medication group. Treatment adherence was also found to be high, with 96% of scheduled doses administered within ±7 days.

Based on these study results, the 2025 European AIDS Clinical Society (EACS) removed HIV Subtype A1, which had previously been identified as a risk factor for virologic failure and resistance in certain ethnic groups when switching to the Vocabria + Rekambys combination therapy.

Currently, the Vocabria + Rekambys combination therapy is the only long-acting HIV injectable treatment available in Korea. It is being used as a switch therapy option to improve treatment convenience and quality of life in adult patients whose viral load has been stably suppressed through existing treatments.

This treatment has reportedly accumulated more than 1,000 treatment cases within about one year since its launch in Korea last April.