Lenacapavir: a revolutionary advance in HIV prevention faces access challenges.

The discovery of Lenacapavir as a revolutionary treatment for the prevention of HIV has marked a milestone in the fight against this epidemic, which has claimed the lives of 40 million people in recent decades. This antiviral, administered via injection every six months, has been recognized as the major scientific breakthrough of 2024 by the journal Science, highlighting its potential to change the course of HIV prophylaxis. Although it is not yet a vaccine, its effectiveness could bring us closer to a future where the virus is significantly less prevalent. Results from a Phase III clinical trial, presented at the International AIDS Conference, show that Lenacapavir has demonstrated 100% efficacy in preventing HIV in over five thousand women in South Africa and Uganda. This finding, led by Zimbabwean scientist Linda-Gail Bekker, has generated renewed optimism in the scientific community and health organizations, who see this antiviral as a powerful tool to reduce the transmission of the virus. However, despite its potential, the path toward widespread implementation of Lenacapavir is fraught with uncertainties. Approval is expected by mid-2025, but the cost of the treatment remains a critical factor that will determine its accessibility. Currently, the treatment version of Lenacapavir has an exorbitant cost exceeding $41,000 per year, making it an unattainable option for most people living with HIV or at risk of infection. Pharmaceutical giant Gilead has expressed its intention to work on producing generic versions at a much lower cost, estimating that they could set the price at around $40 annually. This figure, while more accessible, is still problematic for many, as middle-income countries like Brazil might not benefit from these low-cost versions, leaving a large number of seropositive individuals without access to effective treatments. Vanessa López, director of the NGO Salud por Derecho, emphasized that the semiannual administration of Lenacapavir would facilitate adherence to treatment, a crucial factor in the fight against HIV. The possibility of reducing the risk of infection with just two injections a year represents a significant advancement compared to current prophylaxis options, which require more consistent and rigorous adherence. Sharon Lewin, president of the International AIDS Society, also highlighted Lenacapavir's enormous potential, stressing that its rapid and equitable distribution could accelerate global progress in HIV prevention. However, the challenge of health equity persists, and many advocate for broader and fairer access to this medication, especially in the most needy countries. Globally, organizations and activists have called on Gilead to reduce the cost of Lenacapavir and ensure that this vital treatment reaches the populations that need it most. The fight for public health and access to treatments is intensifying, as each year, thousands of people continue to be diagnosed with HIV worldwide. In parallel, Gilead is conducting another clinical trial called 'Purpose 2', which explores the use of Lenacapavir in different populations to assess its efficacy in reducing the transmission of the virus.