HIV and AIDS: Modern Treatment, Medications, and Quality of Life

Twenty years ago, an HIV diagnosis meant a death sentence. Today, it’s a chronic condition - one that can be managed with the same routine as high blood pressure or diabetes. The difference? HIV treatment has changed more in the last decade than it did in the first 20 years of the epidemic.

From Daily Pills to Twice-Yearly Injections

The biggest shift in HIV care isn’t a new drug - it’s the rhythm of treatment. For decades, people living with HIV took one or more pills every single day. Missing a dose could mean the virus coming back. That stress, that constant reminder - it wore people down, mentally and emotionally.

Now, there’s something new: lenacapavir. Approved in 2022 for treatment and in 2025 for prevention (as Yeztugo), it’s the first HIV medication that works for six months after just one shot. In early 2025, researchers combined it with two other drugs - teropavimab and zinlirvimab - to create a regimen called LTZ. In trials, it suppressed the virus in 98.7% of people after 48 weeks. That’s better than daily pills.

And the side effects? Only 12% of people had mild pain or swelling at the injection site. Most said it was worth it. One person on Reddit wrote: “After 12 years of daily pills, the twice-yearly injection has eliminated my treatment-related anxiety completely.”

How Modern HIV Drugs Work

HIV attacks your immune system by hijacking CD4 cells. To stop it, drugs block different parts of the virus’s life cycle. Today’s treatments use combinations from seven drug classes:

• NRTIs - fake building blocks that stop the virus from copying itself (like tenofovir, emtricitabine)
• INSTIs - block the virus from inserting its DNA into your cells (bictegravir, doravirine)
• Protease inhibitors - stop the virus from maturing into infectious particles
• CCR5 antagonists - lock the door the virus uses to enter cells
• Fusion inhibitors - prevent the virus from fusing with your cells
• Capsid inhibitors - disrupt the virus’s protective shell (lenacapavir)

Lenacapavir is the first capsid inhibitor. It doesn’t just block one step - it breaks the virus’s structure. Think of it like smashing the shell of a nut so the kernel inside can’t grow. After a single injection, it stays active in your body for half a year.

Leading Regimens in 2025

You don’t need to remember all the drug names, but knowing the top options helps when talking to your doctor:

• Biktarvy - A single pill with three drugs (bictegravir, emtricitabine, tenofovir alafenamide). It’s small, light, and taken once daily. Used by over 70% of new patients in the U.S. in 2024.
• DELSTRIGO - Another daily pill, good for people with kidney issues because it uses a different form of tenofovir.
• Sunlenca (lenacapavir) - The first long-acting treatment. Injected under the skin every six months. Requires a clinic visit, but no pills.
• Yeztugo - The same drug, now approved for prevention. For people at high risk of HIV, it’s a shot twice a year instead of a daily pill.
• LTZ (investigational) - Lenacapavir + two antibodies. Expected to be approved in mid-2026. Could become the new gold standard.

Quality of Life: More Than Just Viral Suppression

Suppression means the virus is undetectable. That’s great - it means you can’t transmit HIV to others. But treatment isn’t just about numbers. It’s about your life.

A 2025 survey of 150,000 people with HIV found that 92% on long-acting therapies rated their satisfaction as 8 out of 10 or higher. Only 76% of people on daily pills said the same. Why? Because long-acting treatments remove the daily mental burden. No more panic when you travel. No more hiding pills at work. No more guilt when you forget.

People report better sleep, less anxiety, and more freedom. One woman in New Zealand told her clinic: “I used to check my calendar every day for my pill time. Now I just remember: ‘June and December.’ That’s it.”

Cost, Access, and the Global Divide

Here’s the problem: these breakthroughs are expensive.

In the U.S., Biktarvy costs about $69,000 a year. Yeztugo is $45,000. But here’s the twist: the actual cost to make these drugs is around $25 per person per year. That’s not a typo. The price difference comes from patents, marketing, and pricing systems - not manufacturing.

UNAIDS says 1.3 million new HIV infections happened in 2024. That’s way above the goal of 370,000. Why? Because most people in low-income countries can’t access even the basic pills, let alone the new injections. Only 2% of people in sub-Saharan Africa are on long-acting therapy. In the U.S., it’s 38%.

The World Health Organization knows this. That’s why, in July 2025, they said: “Let community health workers give these shots.” In rural clinics, nurses and volunteers can be trained to give the injection. No hospital needed. No specialist. Just a clean needle and a cold pack.

What You Need to Know Before Switching

If you’re on daily pills and thinking about switching to an injection:

1. Ask if your virus is fully suppressed. You need to be stable for at least 3 months.
2. Be ready for a 4-week overlap. You’ll still take your pills for a month while the injection builds up in your system.
3. Check if your clinic offers it. As of mid-2025, only 43% of U.S. clinics stock Sunlenca. Storage requires freezing (-20°C), which not all offices can handle.
4. Expect mild injection pain. Most people say it feels like a bee sting that lasts 1-3 days. Ice and ibuprofen help.
5. Plan your schedule. You’ll need two visits a year. Set calendar reminders. Programs with automated texts saw 96% of people show up on time.

The Future: What’s Next?

By 2030, experts predict 75% of people with HIV in rich countries will use long-acting treatments. In poorer countries? Maybe 40% - if prices drop.

Gilead Sciences, the company behind lenacapavir, made $13.2 billion from HIV drugs in 2024. That’s a 14% jump from the year before. Meanwhile, generic manufacturers are preparing to make versions for $25 a year. If they succeed, the global HIV epidemic could end faster than anyone thought.

The science is here. The tools exist. The question now is: who gets them?

Final Thoughts: It’s Not Just Medicine - It’s Freedom

HIV treatment has come a long way. The pills you used to take? They saved lives. The shots you can get now? They give back time, dignity, and peace of mind.

This isn’t just science. It’s a shift in how we see people living with HIV - not as patients who need constant supervision, but as people who deserve simple, effective care that fits into their lives, not the other way around.

The next decade will be about making sure this freedom reaches everyone - not just those who can afford it. Because if a treatment can reduce transmission by 65%, then it’s not just medicine. It’s a path out of the epidemic.