Single pill could replace multi-tablet regimens for complicated HIV, says study

A new, daily tablet might be able to effectively replace more complicated HIV treatments for long-term survivors, suggests a new study published in The Lancet.

The phase 3 clinical trial, which included more than 550 people living with HIV across 15 countries, showed that the new single pill treatment – consisting of bictegravir and lenacapavir – was highly effective in controlling the HIV virus in individuals who had engaged with treatment for a median of 28 years.

Professor Chloe Orkin, Clinical Professor of Infection and Inequities at Queen Mary University of London said: ‘Simplifying HIV treatment from handfuls of pills at the start of the epidemic to one pill a day has improved clinical outcomes for most people living with HIV.’

‘However, until now, some people with resistant virus or clinical contraindications [have been unable to] take these simpler regimens and must instead take complex regimens which may place them at risk of drug interactions.’

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‘[These] findings are game changing for this group of people, many of whom have lived with HIV for decades, and who have other cardiovascular conditions associated with aging.’

While most people with HIV already take a single daily pill or use two-monthly injections for viral control, some people whose virus harbours resistance have not benefitted from these simpler treatments and remain on complex multi-tablet treatments.

The people who are in this situation are typically older adults who were diagnosed with HIV early in the HIV-1 epidemic in the 1980s or people born with HIV-1, with decades of antiretroviral therapy experience resulting in a higher likelihood of resistance.

Most participants on this trial reported taking at least three pills per day with a maximum of 11 pills. Three-quarters were on a complex regimen that included a protease inhibitor, and a third were taking four or more antiretroviral tablets per day.

Additionally, the median age of participants was 60 years – making this the oldest median age of any registration trial in HIV so far.

The study found that nearly 96% of participants who switched to the simplified single-pill regimen maintained viral suppression with no new drug resistance reported, which was very similar to participants who continued with their existing complex, multi-pill treatments.

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However, participants also reported that the new single-pill treatment option was easier and more convenient to take, which the researchers say often helps to support consistent adherence to daily medication.

In the context of England, the UNAIDS 95-95-95 targets were met again in 2024. With provisional data showing that 95% of all people with HIV in England were diagnosed, 99% of people diagnosed were receiving treatment, and 98% of people receiving treatment were virally suppressed and unable to pass on the virus.

Consequently, in December 2025, the government unveiled its HIV Action Plan for England, 2025 to 2030, which aims to end new HIV transmissions in England by 2030.

Wes Streeting, secretary of state for health and social care, said: ‘The HIV Action Plan is a collective commitment to one of the most ambitious public health goals of our time.’

‘We are trying to do something that has never been done before: to stop the onward transmission of a virus without a vaccine or a cure. We are determined to succeed.’

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The age profile of people receiving HIV care in England in 2024 is an aging population– with over half (52%) aged 50 years and over in 2024 compared to 26% in 2015, reflecting past efforts to manage transmission.

A version of this article was first published on our sister title The Pharmacist.