Back in the mid 1990s, treating HIV meant taking a dozen or more pills a day, on a strict schedule, with side effects bad enough that a lot of people just stopped. Today, most people starting treatment take just one pill a day. Some get a shot instead, once every two months. And since June 2025, someone who wants to prevent HIV can get a shot just twice a year that, in trials, kept more than 99.9 percent of people HIV negative. Someone diagnosed today who starts treatment right away can expect to live close to a normal lifespan, and once their virus is undetectable, they can't pass it on through sex.
That's the good news. Here's the rest of it. About 1.2 million Americans live with HIV, and roughly 13 percent of them don't know it. In 2023, more than 100 people were still being newly diagnosed every day. There's still no cure and no vaccine. This article covers what treatment and prevention look like today, what researchers are testing right now, and where clinical trials fit in.
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What HIV treatment includes today
One pill a day. Antiretroviral therapy, or ART, combines two or three medicines that block the virus in different ways, usually packed into one tablet. Common options include bictegravir based combinations (Biktarvy) and dolutegravir based ones. Started early and taken consistently, ART brings the virus down below detectable levels within a few months, lets the immune system recover, and stops it from being passed on through sex. Doctors call this U equals U: undetectable equals untransmittable.
Long acting injections. For people who are already undetectable, cabotegravir plus rilpivirine (Cabenuva) can replace daily pills with a shot every two months. Lenacapavir (Sunlenca), given about twice a year, is approved for people whose virus has stopped responding to many other drugs.
Prevention: PrEP. Pre exposure prophylaxis means someone who is HIV negative takes medicine to stay that way. It started with a daily pill (Truvada, later Descovy), then added a shot every two months (Apretude), and in June 2025 the FDA approved lenacapavir, under the brand name Yeztugo, as the first PrEP option that only needs to be taken twice a year. In the PURPOSE 1 trial, which included more than 2,000 women, not a single person on lenacapavir got HIV. In PURPOSE 2, 99.9 percent stayed negative. The CDC added it to its prevention guidelines in September 2025.
What still hasn't happened. A cure and a vaccine. Several large HIV vaccine trials have been stopped in recent years after failing to show real protection. And treatment, as good as it's gotten, still has to be lifelong, because HIV hides inside resting immune cells that drugs can't reach. Stop taking the medicine, and the virus comes back within weeks.
What researchers are studying now
Longer, simpler, fewer. The direction treatment is heading is clear: fewer doses, spaced further apart. On our platform, a study of ultra long acting cabotegravir plus rilpivirine is testing whether treatment shots can be stretched out even further, and Gilead is testing GS-3242 combined with lenacapavir against Biktarvy in people who are already undetectable, aiming for a shot that only needs to be given twice a year. Merck's islatravir and ulonivirine study is testing a new once a week combination.
Prevention you take once a month. A large study of MK-8527 is testing a once a month PrEP pill, which would sit somewhere between the daily pill and the twice yearly shot, for people who want to avoid injections.
Cure research, carefully. A trial of combination broadly neutralizing antibodies, lab made antibodies that recognize many strains of HIV at once, enrolls people in the very first weeks after infection, when the hidden reservoir of the virus is at its smallest. And in one of the more unexpected studies out there, researchers are testing whether alendronate, a drug normally used for osteoporosis, can affect that hidden reservoir. These are still early studies. Nobody is promising a cure, and everyone taking part stays fully protected by their regular HIV treatment.
Living long with HIV. Because people with HIV now live for decades, researchers are also studying the health conditions that come with getting older, sometimes earlier than expected. A study of inflammation and depression in people with HIV and a program to improve heart health in people living with HIV both reflect a simple reality: HIV care today is mostly about everything else.
Why HIV research works differently now
The comparison problem. Since such good treatment already exists, no trial can compare a new drug against nothing. New medicines have to be tested against approved treatments and match how well those already work, and matching a treatment that keeps well over 90 percent of people undetectable doesn't leave much room to improve on. That's why so many trials today are really testing convenience, longer gaps between doses, fewer pills, rather than raw effectiveness.
The reservoir problem. HIV inserts its genetic code into resting immune cells, where it sits silently, invisible to both drugs and the immune system. Every cure strategy out there has to either wake those cells up and destroy them, keep them permanently silent, or replace the immune system entirely. All three approaches have been tried, and none has worked at a large scale yet. This is the hardest problem in the whole field.
The reach problem. Science has moved faster than the system around it. A shot that prevents HIV for six months at a time already exists, and yet more than 100 people a day are still being diagnosed, and 13 percent of people with HIV don't know they have it. A lot of current studies are really about getting things to people, self testing kits, telehealth, combining HIV care with substance use treatment. In 2025, cuts to federal HIV prevention programs made this gap a real, immediate concern for the people running these studies.
The representation problem. New HIV infections in the US fall hardest on Black and Latino gay and bisexual men, Black women, and the South, yet trial participants have historically skewed white and male. The PURPOSE trials stood out partly because they enrolled women first, then men and gender diverse people. Several current studies recruit specifically in the communities most affected. Here's why diversity in clinical trials matters so much.
Common myths about HIV
"HIV is a death sentence."
Not anymore, and hasn't been for decades. With prompt, steady treatment, life expectancy is close to normal. The people actually at risk today are those who don't know they have it or aren't getting care, not those who are being treated.
"You can tell if someone has HIV."
You can't. Most people have no symptoms for years, which is exactly why 13 percent of people with HIV don't know they have it. The CDC recommends that everyone between 13 and 64 gets tested at least once.
"HIV spreads through casual contact."
No, it doesn't. It spreads through blood, semen, rectal and vaginal fluids, and breast milk, mainly through sex without protection and shared needles. Not through kissing, hugging, sharing food, using the same toilet, or mosquito bites.
"PrEP is only for gay men."
PrEP is for anyone who could be exposed to HIV, including women, heterosexual men, and people who inject drugs. The 100 percent result in the lenacapavir PURPOSE 1 trial actually came from a study of women.
The stages of HIV, and what care usually looks like
Acute HIV is the first few weeks after infection, when the virus level is at its highest and flu like symptoms are common. Starting treatment right at this stage is ideal, and it's exactly what cure research is aiming for. Chronic HIV is the long stage that follows, often decades on treatment, where the typical picture is one pill a day or a shot every two months, regular checks of your viral load, and keeping an eye on heart, bone, and mental health. AIDS is diagnosed when the CD4 count drops below 200 or an opportunistic infection shows up, and it's now rare in people who are on treatment. This describes usual practice, not a recommendation, your plan belongs to you and your HIV doctor.
For trials, the eligibility language tells you who qualifies: "treatment naive," "virologically suppressed," "acute infection," or "PrEP." Knowing your HIV status, your latest viral load and CD4 count, and what you're currently taking is enough to filter through studies in minutes.
How to find an HIV clinical trial
AllClinicalTrials.com lists HIV studies recruiting across the US, everything from long acting treatment and PrEP to cure research and care delivery. Two examples recruiting right now: the MK-8527 study of a once a month PrEP pill for HIV negative adults, and the ultra long acting cabotegravir plus rilpivirine study for people living with HIV who are already undetectable on treatment.
The application takes about 5 minutes. You'll answer questions about your HIV status, current medicine, and health history, and if a study near you looks like a match, the research team reaches out to you. Your information is kept private, and nothing is decided until you go through informed consent. You can stop taking part at any point. Three things to have ready: your HIV status and, if positive, your latest viral load and CD4 count; your current HIV medicine or PrEP; and how long you've been taking it.
Common questions
What is the best treatment for HIV? For most people, it's a single daily pill combining two or three antiretrovirals, started as soon as possible after diagnosis. For people who are already undetectable, a shot every two months is an approved alternative. The right choice for you depends on your resistance test, any other medicines you take, and your own preference.
What is the newest HIV medication? The biggest recent approval is lenacapavir (Yeztugo) for prevention in June 2025, the first PrEP option that only needs to be taken twice a year. On the treatment side, long acting shots are the newest category, and studies testing twice yearly treatment shots and once a week pills are recruiting right now.
Can HIV be cured? Not yet. A small number of people have been cured through stem cell transplants done for cancer, but that's a procedure far too risky to use for HIV alone. Current research is testing lab made antibodies and drugs aimed at the hidden reservoir of the virus. Treatment, in the meantime, already makes HIV undetectable and untransmittable.
Do HIV trials use a placebo? Treatment trials never leave anyone without treatment, new drugs are always compared against already approved ones. Prevention trials compare a new PrEP option against an approved one, not against nothing at all. Some cure and behavioral studies do use a placebo, but always on top of standard treatment.
See HIV clinical trials recruiting now
Browse open studies, filter by location, and apply in about 5 minutes: HIV Clinical Trials