HIV Therapy: The Latest Developments in Antiviral Drugs—A Scoping Review

TL;DR

This review maps recent advances in HIV drugs, including new molecules and long-acting delivery systems, aiming to improve treatment and prevention.

Contribution

The study provides a comprehensive scoping review of novel HIV drugs and delivery platforms in clinical development.

Findings

Capsid inhibitors like lenacapavir show promise for multidrug-resistant HIV and prevention.

Long-acting injectable therapies such as cabotegravir/rilpivirine are advancing for maintenance treatment.

Broadly neutralizing antibodies may enable ART-free viral suppression in some patients.

Abstract

Background: Major advances in antiretroviral therapy (ART) have transformed HIV into a chronic condition, yet drug resistance, long-term toxicities, adherence challenges, and persistent viral reservoirs continue to drive innovation. Objectives: To map and synthesize recent developments in anti-HIV drugs and delivery platforms with a focus on (i) new molecules in clinical development and (ii) novel mechanisms of action, following a scoping review framework aligned with PRISMA-ScR. Sources: We interrogated PubMed, Embase.com, Web of Science, and Scopus (January 2020–September 2025) and screened abstracts from CROI, IAS/AIDS, IDWeek, and HIV Glasgow (2023–2025). Content: The evidence base underscores capsid inhibition (lenacapavir) for multidrug-resistant HIV and its expansion into prevention, long-acting intramuscular maintenance with cabotegravir/rilpivirine, maturation inhibitors (zabofiravir), and attachment inhibition with fostemsavir. Broadly neutralizing antibodies (bNAbs) can sustain ART-free suppression in selected individuals. Ultra-long-acting delivery systems are advancing toward translational evaluation. Summary: The pipeline is diversifying toward less frequent dosing, new targets, and combination strategies. Successful and ethical implementation will require resistance-informed selection, equitable access, and reimagined healthcare delivery models that accommodate long-acting technologies.

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