A breakthrough in HIV prevention is taking shape as philanthropic organizations and drugmakers announced agreements to slash the cost of lenacapavir, a long-acting injectable that offers near-total protection against the virus. The deals, revealed on Wednesday, bring the annual price down to $40 per patient in 120 low- and middle-income countries, putting the drug within reach of regions where resources are tight but the burden of infection is high.
Lenacapavir, marketed as Yeztugo by Gilead Sciences, is administered as two injections per year and demonstrated more than 99 percent effectiveness in clinical trials. The twice-yearly schedule provides a major advantage over daily oral prevention pills, which, while effective, face obstacles in adherence and stigma, particularly among women in low-income settings.
Until now, cost had been the most significant barrier. In the United States, the drug launched with a list price of more than $28,000 per year, comparable to cabotegravir, the other long-acting injectable on the market. But recent partnerships—with Indian generics manufacturers Dr. Reddy’s Laboratories and Hetero, backed by the Clinton Health Access Initiative, Unitaid, Wits RHI, and the Gates Foundation—will cut that figure down to $40 in targeted countries. Generic versions are expected to be available starting in 2027.
Experts say the price point, while promising, is only a first step. About 1.3 million people worldwide are newly infected with HIV each year, and epidemic control in sub-Saharan Africa alone could require preventive access for as many as 40 million people. The Global Fund and PEPFAR have announced plans to provide lenacapavir to two million people by 2028, but advocates argue that far more investment is needed to meet global demand.
Questions remain over how already-stretched health budgets will accommodate even the reduced cost, with countries still grappling with malaria, tuberculosis, and malnutrition. Global health programs are also facing funding cuts that could constrain rollout. Critics argue that bridge funding from U.S. programs like PEPFAR will be essential if the agreements are to have real impact before generics enter the market.
Despite the uncertainties, the introduction of a twice-yearly, low-cost injectable represents a significant milestone in a fight that has stretched more than four decades. If financing and distribution challenges can be met, lenacapavir could reshape the global approach to HIV prevention.