Gilead Sciences is set to distribute its innovative HIV prevention drug, Lenacapavir, to 120 countries, primarily low-income and resource-limited, through royalty-free voluntary licensing agreements. This long-acting injectable, administered twice yearly, has demonstrated significant efficacy in reducing HIV transmission, particularly in high-risk populations during global clinical trials. However, the distribution plan has faced criticism for excluding several high-incidence countries.
Lenacapavir's Efficacy in HIV Prevention
Lenacapavir has shown remarkable efficacy in preventing HIV infections, outperforming traditional daily oral pre-exposure prophylaxis (PrEP). The PURPOSE 1 and PURPOSE 2 trials revealed that participants receiving the bi-annual injection had a significantly lower risk of contracting HIV. These trials included participants from South Africa, Uganda, and Brazil, with such promising results that some studies were halted early to accelerate regulatory approval. Gilead anticipates initiating global filings for PrEP approval by the end of 2024.
The drug functions by inhibiting a crucial protein for HIV replication. Unlike daily PrEP pills, its twice-yearly administration offers a more convenient and potentially more effective prevention method for individuals challenged by daily medication adherence.
Access Limitations and Criticisms
While the initiative to make Lenacapavir available in 120 countries is a significant advancement, it has been criticized for excluding middle- and high-income nations with high HIV infection rates. Countries like Brazil, Mexico, and Colombia, which account for a substantial portion of new HIV infections in Latin America, are not included in the agreement. Critics argue that Gilead’s focus on low-income countries leaves a significant portion of the global population vulnerable.
Advocacy groups, including the AIDS Healthcare Foundation (AHF), have voiced their concerns, accusing Gilead of prioritizing profit over access in excluded regions. AHF President Michael Weinstein emphasized that the drug should be affordable to all nations that need it, regardless of income classification, and suggested that excluded countries should use legal mechanisms like compulsory licenses to ensure access. Concerns also exist regarding the pricing of the drug in included countries, which could limit its accessibility.
Focus on Sub-Saharan Africa and Southeast Asia
The 120 countries included in the rollout encompass some of the most affected by the HIV epidemic, such as South Africa, Kenya, Mozambique, Ethiopia, and Thailand, representing nearly 70% of the global HIV burden. To expedite availability, Gilead has partnered with six generic manufacturers, including Dr. Reddy’s Laboratories, Emcure Pharmaceuticals, and Hetero Labs, to produce low-cost versions of Lenacapavir.
South Africa, with one of the highest HIV rates globally, is expected to benefit significantly. However, some critics suggest that greater involvement of the domestic pharmaceutical industry in the manufacturing process could have further reduced costs and accelerated distribution.
Broader HIV Response and Future Directions
UNAIDS and other global health organizations have welcomed the expansion of Lenacapavir but continue to advocate for broader access to ensure the medication reaches everyone in need. With 40 million people living with HIV globally and new infections occurring at an alarming rate, particularly among vulnerable populations, affordable and effective prevention tools like Lenacapavir are crucial in the fight to end the epidemic. UNAIDS has emphasized that Lenacapavir can only accelerate efforts to end AIDS if Gilead ensures access for all who need it. As further clinical trials progress and regulatory approvals are anticipated, there is hope that Gilead will expand its voluntary licensing agreements to include the excluded countries, ensuring comprehensive global access.
