Senior Consultant, Infectious Diseases, Fortis Memorial Research Institute, Gurgaon
Part 9 of 9 in Tuberculosis & HIV - An Insight
Long-Acting HIV Therapy and the Path Toward a Cure
September 6, 2026
Across a career spent running an HIV clinic of about 2,300 patients across her state over four and a half years, Dr. Rastogi Panda has already moved close to 670 of them onto two-drug maintenance therapy, part of a broader shift in HIV care toward fewer pills, longer intervals between doses, and, in a small but real number of cases, an actual cure.
Maintenance Therapy Without a Daily Pill
Cabotegravir, a long-acting integrase inhibitor, combined with rilpivirine, a non-nucleoside reverse transcriptase inhibitor, has a half-life of around 24 to 26 weeks. Given as a single intramuscular or subcutaneous injection, the combination maintains viral suppression for close to three months in patients who are already stable on oral therapy, replacing daily dosing with a visit every three months instead. It is a maintenance option for patients already suppressed, not a starting regimen for a newly diagnosed patient.
Fewer Drugs Is Now a Deliberate Strategy
Two-drug regimens, rather than the traditional three-drug backbone, are increasingly used for stable patients specifically because fewer drugs means fewer side effects, fewer drug interactions and simpler dosing without a meaningful loss of viral control. This mirrors the same logic behind long-acting injectables: reducing the daily burden of managing a chronic disease and improving the odds that a patient stays on treatment for decades rather than years.
Bone Marrow Transplant: A Cure by Accident, Now Studied on Purpose
HIV entry into cells depends on the CCR5 and CXCR4 receptors. When a person with HIV needed a bone marrow transplant for an unrelated blood cancer and received marrow from a donor carrying a double mutation in these receptors, their own marrow, the most protected reservoir the virus has, came back free of detectable HIV RNA for a full year and they were subsequently declared cured. Around eight people worldwide have now been cured this way. Dr. Rastogi Panda's own hospital has performed two bone marrow transplants in HIV-positive patients: one with Hodgkin lymphoma, who later died of an opportunistic pneumonia, and one with acute myeloid leukaemia, who is alive and doing well. Bone marrow transplant is not an approved treatment specifically for HIV; both cases were transplants for the underlying cancer that happened to also clear the HIV infection.
A Longer Life Changes What Success Looks Like
One of Dr. Rastogi Panda's long-standing HIV patients recently marked a personal milestone birthday at a routine clinic visit, cake in hand, decades into a normal, ordinary life on therapy. She sums up the current state of HIV care with a reframing of the disease's own name: HIV, in her telling, now stands as much for hope and a high cure rate as it does for the virus itself, provided diagnosis is early, monitoring is vigilant, and the patient stays on treatment.
This guide is based on a live Jivo Masterclass: Dr. Neha Rastogi Panda taught doctors across Africa on March 30, 2025.
FROM THE LIVE Q&A
Dr. Emanuela
What are the early signs of HIV?
Dr. Neha Rastogi Panda
The early signs, known as acute HIV syndrome, look like a flu. Most patients who are symptomatic present with intermittent fever for two to three months, fatigue or weakness, weight loss, loss of appetite, cough, cold, sore throat, more frequent minor illnesses than usual, and loose motions or diarrhoea. This symptom complex over the first month or two is what we call acute HIV syndrome.
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Frequently Asked Questions
Why don't we use the urine LAM test and stool test for all patients?▼
The urine lipoarabinomannan (LAM) test is reserved for tuberculosis diagnosis, and it has only been validated for patients with a CD4 count below 100. Below that threshold, a high tuberculosis bacterial burden allows the antigen to wash out into the urine; above it, the test loses sensitivity and specificity, so extrapolating it to every patient isn't supported. On stool testing for other opportunistic infections, a high viral load before treatment changes the normal gut flora, so a stool sample will often show excess normal flora and candida, which makes interpreting it for treatment decisions difficult specifically in HIV patients.
Are there any antiretrovirals that can have prolonged action for up to three or six months?▼
Yes. Cabotegravir, a longer-acting integrase inhibitor, combined with rilpivirine from the non-nucleoside reverse transcriptase inhibitor family, was studied in the TANGO trial and showed viral suppression sustained for close to three months from a single dose. Their half-life runs to about 24 to 26 weeks, so the combination is given as one intramuscular or subcutaneous injection every three months for patients who are already stable on oral therapy, as maintenance rather than as a starting regimen.
At what stage can we diagnose opportunistic infections, and how do we diagnose them?▼
Opportunistic infections can be diagnosed at any stage; the WHO staging system, grade one through four, is built around exactly this, using the infection profile and CD4 level together. Oral thrush, for instance, usually appears at stage two, while reactive generalised lymphadenopathy sits at stage one. Sometimes the opportunistic infection is itself the first clue to an undiagnosed HIV infection, tuberculosis being the clearest example: finding it usually puts the patient at WHO stage three, and a very low viral load and CD4 count below 200 to 250 lets you further risk-stratify from there. Diagnosis runs on three legs: the clinical symptoms and signs, which organ is involved, and targeted sampling, such as testing sputum by GeneXpert for suspected pulmonary tuberculosis, or testing CSF, or serum cryptococcal antigen when CSF isn't accessible, for cryptococcal meningitis.
What are the early signs of HIV?▼
The early signs, known as acute HIV syndrome, look like a flu. Most patients who are symptomatic present with intermittent fever for two to three months, fatigue or weakness, weight loss, loss of appetite, cough, cold, sore throat, more frequent minor illnesses than usual, and loose motions or diarrhoea. This symptom complex over the first month or two is what we call acute HIV syndrome.
In This Series: Tuberculosis & HIV - An Insight
- 1.Tuberculosis and HIV
- 2.How HIV Is Diagnosed: Getting the Testing Window Right
- 3.Starting Antiretroviral Therapy: Building the Regimen Around the Patient
- 4.Pre-Exposure Prophylaxis for HIV: Who Qualifies and How Well It Works
- 5.Post-Exposure Prophylaxis: Acting Within 72 Hours of a Possible HIV Exposure
- 6.Tuberculosis and HIV Co-Infection: Why the Two Diseases Compound Each Other
- 7.Preventing Mother-to-Child Transmission of HIV
- 8.When HIV Therapy Appears to Fail: Telling Adherence Problems From Real Failure
- 9.Long-Acting HIV Therapy and the Path Toward a Cure