Ask AI
Back Back1

Embracing Choice: The Role of Oral Regimens as a Bridge to Long-Acting ART

Start Activity
Clinical Thought
Clinical Thought Start Activity
See Activity Information

Released: September 24, 2026

See Activity Collection

Step 1 of 2

1 ClinicalThought 2 Complete Activity

Historically, initial antiretroviral therapy for people living with HIV has prioritized rapid and durable virologic suppression with effective oral regimens. Although viral suppression remains the primary goal, long-term success also depends on treatment satisfaction, lifestyle considerations, and sustained engagement in care. Here, I discuss how the VOLITION study represents a contemporary HIV treatment journey in which initial oral ART naturally evolves into a choice regarding long-term treatment for maintenance of viral suppression. These findings support a patient-centered approach to HIV care, where achieving viral suppression is the foundation for subsequent treatment options that reflect individual needs, preferences, and lifestyle considerations.

Charlotte-Paige Rolle
Charlotte-Paige Rolle, MD, MPH
Oral Regimens to Bridge Long Acting ART

Continue

To date, initial antiretroviral therapy (ART) for people living with HIV has largely focused on achieving rapid and durable virologic suppression through effective oral regimens. Although viral suppression remains the primary treatment goal, regimen optimization and long-term success also depend on patient preference, treatment satisfaction, lifestyle considerations, and sustained engagement in care. The phase IIIb VOLITION study provides important evidence that an initial choice of oral ART may also serve as a pathway to a subsequent, patient-determined choice regarding whether to remain on oral therapy or transition to a long-acting (LA) injectable regimen.

Bridging the Gap From Oral to LA ART
In VOLITION, treatment-naive adults with HIV initially received the oral 2-drug regimen dolutegravir/lamivudine (DTG/3TC). The study was specifically designed to evaluate whether individuals who achieved virologic suppression on oral therapy would choose to continue daily tablets or switch to LA injectable cabotegravir plus rilpivirine (LA CAB + RPV), administered every 2 months. This design reflects a real-world treatment scenario in which the initial oral regimen serves not only as an effective means of achieving viral suppression but also as a bridge to future treatment options. [coder link to: https://deceraclinical.com/education/activities/infectious-disease/art-simplification-1/162617/content]

The results demonstrated that DTG/3TC as initial ART achieved rapid virologic suppression. Among 171 participants who initiated therapy, 98% achieved virologic suppression, with a median time to suppression of 4.1 weeks. These findings highlight the ability of this 2-drug oral ART to quickly establish the virologic control necessary for considering alternative maintenance strategies. 

Prioritizing Patient Choice Is Not a Bridge Too Far
I think the most notable study finding was the strong preference for LA injectable therapy once suppression had been achieved. At the “Day of Choice” visit, 85% of eligible participants elected to switch from oral DTG/3TC to LA CAB + RPV rather than continue daily oral treatment. This observation suggests that many individuals view oral ART not as a permanent destination but as an effective first step towards accessing a treatment modality that better aligns with their personal preferences and lifestyle needs.

Patient-reported outcome data from VOLITION provides additional context for this preference. Participants who chose injectable therapy cited convenience, reduced pill burden, and psychological benefits as the top 3 reasons for switch. Having the option to switch to LA injectable therapy was associated with feelings of greater freedom, autonomy, and control over HIV management. These findings underscore that treatment decisions extend beyond clinical efficacy alone and are increasingly influenced by quality-of-life considerations.

Of importance, the transition to LA therapy appeared to maintain the high virologic efficacy achieved by DTG/3TC. At Month 11, 88% of participants who switched to LA CAB + RPV maintained virologic suppression, demonstrating that patient preference can be accommodated while maintaining treatment goals. Safety outcomes were consistent with the established profiles of both DTG/3TC and LA CAB + RPV, and treatment satisfaction remained high following the switch.

Bridging Treatment Goals and Patient Preference
Overall, the VOLITION study represents a contemporary HIV treatment journey in which the initial oral ART choice naturally evolves into a second, equally important choice regarding long-term treatment for maintenance of viral suppression. By using the oral 2-drug regimen of DTG/3TC to achieve rapid suppression and subsequently empowering individuals to choose whether to continue oral therapy or transition to LA CAB + RPV, the study highlights the value of shared decision-making. These findings support a patient-centered approach to HIV care, where achieving viral suppression is the foundation for offering meaningful subsequent treatment options that reflect individual needs, preferences, and lifestyle considerations.

Your Thoughts
Would you consider a 2-drug regimen as initial ART? Why or why not? Leave a comment to join the discussion!

Continue