Oral ART or Long-Acting Injectables for HIV: Which Is Right for You?
Published on October 22, 2026
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HIV treatment has evolved considerably since the first antiretroviral drugs reached patients in the late 1980s. A once-complicated multi-pill regimen has, for many people, become a single tablet taken by mouth once a day, a treatment known as oral antiretroviral therapy (ART). More recently, long-acting injectable ART — an intramuscular shot given in a clinic once every one to two months — has become another effective treatment option for people living with HIV.
Which of these two approaches is best for you depends on several factors you should discuss with your healthcare provider, but both treatments can get your viral loads down to undetectable and untransmittable levels. “There's no difference [in effectiveness] between the current oral medications and the injectables,” says Dominic Chow, MD, PhD, MPH, a professor with the Hawai’i Center for AIDS and University of Hawai’i Department of Medicine in Honolulu. “One isn't superior to the other.”
Convenience and Daily Life
Whether to choose pills or injections for your HIV treatment largely comes down to personal preference, says Dr. Chow. “Some people don’t like needles, so in those cases [injections] wouldn’t be a good fit,” he says. “And there are people who have a phobia of pills, and that pushes them toward the injectable.”
Convenience and daily life habits play a significant role for people when they're deciding between the treatment options.
“There are patients who have been waiting their entire lives to not have to take a daily pill for HIV,” says Jill Blumenthal, MD, an infectious disease specialist with UC San Diego Health. For some people, switching to injectables provides a greater sense of freedom and fewer reminders of their HIV status. “So even if it means they have other medications they’re taking every day, the idea of getting rid of one of those, or more than one, is such a bonus for them."
For other people, daily pills are more convenient because they don't need to show up at a clinic, which can be more difficult if you have an unpredictable schedule, a long commute, or stigma-related concerns about being seen in an HIV clinic.
“These aren’t injections that can be done at home,” Dr. Blumenthal says. “So it means being able to say, 'Yes, I can go to the clinic 6 to 12 times a year,' and stay within the dosing window." The best option for you is the one you can maintain consistently without skipping pills or injections.
Treatment Adherence and Potential Pitfalls
Regularly taking your medications as directed is key to reaching and maintaining U=U (undetectable equals untransmittable) status, but some people find the daily regimen difficult to follow. Better treatment adherence is one of the major reasons some people choose injectables over daily pills for HIV treatment. One trial found that switching people with adherence struggles to the monthly injectables cut treatment failure nearly in half.
While it isn't a huge deal to occasionally miss a single dose of your daily oral ART, missing multiple doses may allow the virus to replicate, potentially to transmittable levels. And if you don’t have enough of the medication in your body to fully suppress the virus, the virus may develop resistance to the drug. This is more likely to occur the longer the drug lingers in your system at low levels, Chow says. “Some medications are notoriously long-acting,” he says, “and if people aren’t taking them regularly, the virus can mutate and become resistant.”
It is also possible for the virus to develop resistance to the injectable medications. But this is generally less likely to happen because of the more lenient dosing schedule, which allows you to get the shot within a window of about a week before and after the due date without it counting as a missed dose. And in the rare case when you’ll knowingly miss this window, such as if you’re traveling, your provider can bridge the gap with daily oral pills of the same drugs (cabotegravir and rilpivirine) or other treatment.
Side Effects and Tolerability
Mild, short-term gastrointestinal symptoms like nausea, vomiting, and diarrhea are common for people starting a new oral ART regimen. But they generally resolve on their own within a few weeks as your body adjusts to the medications, and there are multiple things you can do to alleviate the symptoms, such as temporarily changing your diet. Research suggests that fewer than 10 percent of patients on modern oral ART experience side effects serious enough to stop the medication.
“The main side effects we talk about for the injections are injection-site reactions,” Blumenthal says. These reactions are usually mild to moderate, peak during the first few doses, and ease within days. Cold packs, topical steroid creams, and over-the-counter anti-inflammatory medications can quiet these side effects. In one trial, fewer than 2 percent of participants stopped the medication because of injection-site reactions. “Overall, I think most people are very happy with it,” Blumenthal says.
If you or your provider is worried about injection-site reactions, you can take pill versions of the injectable drugs for a month to test your tolerance before fully switching to them.
Eligibility Criteria
Long-acting injectable ART is approved for adults and adolescents 12 and older (weighing at least 35 kilograms, or about 77 pounds) who already have an undetectable viral load because they’re taking oral ART.
“The vast majority of people will qualify for a long-acting injectable,” Blumenthal says, adding that you won’t be eligible to switch if you have a resistance to cabotegravir or rilpivirine or have an active hepatitis B infection (certain oral ART medications also treat hepatitis B).
If you’re interested in switching to long-acting injectable ART, speak with your doctor about your eligibility and preferences — they may also be able to provide information about insurance and cost coverage.
Cost and Insurance
For the medications alone, the costs of oral and long-acting injectable ARTs are roughly comparable. The sticker price for oral regimens varies widely depending on the specific medication, typically ranging between $2,300 and $4,700 a month. The injectables run about $4,600 on the monthly schedule, or about $7,000 on the bimonthly schedule. “But then you have to factor in the injection administration costs that some hospitals charge,” Chow says.
How the medications are billed to insurance may differ. Like most prescriptions, oral ART is usually covered under your plan’s pharmacy benefit. The clinic-administered injectable is often billed under your medical benefit through a “buy-and-bill” arrangement — the clinic purchases the drug and bills your insurance for the medication and the visit together. Some insurance plans route it through a specialty pharmacy instead, which ships the drug directly to your provider’s office. These distinctions can further muddy the actual costs of the medications; plans don’t always publish which medical-benefit drugs they cover (even though they publish pharmacy drug lists), and it can be hard to know what to expect ahead of time.
In practice, most people in the United States pay far less than the list price for medications because insurance and assistance programs — including Medicaid, Medicare, the Health Center Program, and the Ryan White Program’s AIDS Drug Assistance Program — typically absorb the bulk of the cost. Some drugmakers run their own patient assistance programs that help you get free or low-cost ART, with separate copay assistance programs to help insured patients cover out-of-pocket costs.
These programs, however, don’t cover other indirect costs of long-acting injectable ART, such as time off work and reliable transportation needed for routine appointments, which may be significant for people living in rural areas with few nearby clinic options.
Resources We Trust
- Mayo Clinic: How Close Is an HIV Cure?
- Cleveland Clinic: Antiretroviral Therapy
- The Well Project: Resistance
- University of Washington National HIV Curriculum: Switching to Optimize Antiretroviral Regimens
- HIV.gov: Paying for HIV Care and Treatment
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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- Barthold D et al. Preference for Daily Oral Pills Over Long-Acting Retroviral Therapy Options Among People With HIV. AIDS. June 7, 2023.
- Panton L. Injectable Antiretroviral Therapy: Best Practice Guide for Nurses Providing Care to People Living With HIV. British Journal of Nursing. June 6, 2024.
- Living with HIV. Centers for Disease Control and Prevention. October 28, 2024.
- Undetectable = Untransmittable. Centers for Disease Control and Prevention. August 19, 2024.
- Rana AI et al. Cabotegravir Plus Rilpivirine for Persons with HIV and Adherence Challenges. The New England Journal of Medicine. February 18, 2026.
- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Clinical Info HIV.gov. September 24, 2026.
- McGowan JP et al. Use of Injectable CAB/RPV LA as Replacement ART. New York State Department of Health AIDS Institute. February 12, 2026.
- Side Effects. The Well Project. June 27, 2025.
- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: Adverse Effects of Antiretroviral Medications. Clinical Info. September 25, 2025.
- Orkin C et al. Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. The New England Journal of Medicine. March 4, 2020.
- Cabenuva (Cabotegravir Extended-Release Injectable Suspension; Rilpivirine Extended-Release Injectable Suspension), Co-Packaged for Intramuscular Use. U.S. Food and Drug Administration. March 2022.
- HIV and Opportunistic Infections, Coinfections, and Conditions: HIV and Hepatitis B. HIVinfo. March 31, 2025.
- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: Cost Considerations and Antiretroviral Therapy. Clinical Info. September 24, 2026.
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