The U.S. Food and Drug Administration (FDA) has approved lenacapavir, a groundbreaking long-acting HIV prevention drug that provides near-complete protection with just two injections per year. Marketed under the brand name Yeztugo, this drug could be a game-changer in the fight against HIV—if its high cost doesn’t keep it out of reach for those who need it most.

Why Is Lenacapavir a Breakthrough?

Despite decades of progress in HIV treatment, more than a million people are newly infected each year, and an effective vaccine remains elusive. Existing prevention methods, like daily oral pre-exposure prophylaxis (PrEP) pills, have been effective but suffer from inconsistent usage. Many people struggle to take a pill every day, reducing real-world effectiveness.

Lenacapavir changes that. It’s a twice-yearly injection that has shown 99.9% efficacy in clinical trials, making it functionally similar to a highly effective vaccine.

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What the Clinical Trials Showed

• Study 1 (Women in Sub-Saharan Africa): Over 2,000 participants, zero HIV infections—a 100% prevention rate, outperforming the daily pill Truvada.
• Study 2 (Men & Gender-Diverse Individuals): Over 2,000 participants, only two infections—a 99.9% prevention rate, again surpassing Truvada.

Side effects were mild, including injection site reactions, headache, and nausea. The results were so compelling that Science named lenacapavir its 2024 “Breakthrough of the Year.”

The Cost Problem: Will This Drug Actually Reach Those Who Need It?

While the science is revolutionary, pricing remains a major hurdle.

• The current list price for lenacapavir (when used as an HIV treatment) is $39,000 per year.
• Analysts estimate the preventive version (Yeztugo) could cost $25,000 annually in the U.S.
• By comparison, cabotegravir, another long-acting HIV prevention shot (administered every two months), costs tens of thousands per year and has seen limited global adoption due to cost.

Activists Demand Affordable Pricing

Public health experts argue that high prices could stall progress in ending the HIV epidemic.

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• Andrew Hill (Liverpool University): Found that lenacapavir could be mass-produced for just $25 per person per year.
• Winnie Byanyima (U.N. Under-Secretary-General): Called excessive pricing “abhorrent,” stating, “We cannot end AIDS with medicines that are so costly.”

Gilead Sciences, the maker of Yeztugo, has not yet disclosed pricing but faces pressure to lower costs for widespread accessibility.

Political Challenges: Funding Cuts Threaten HIV Progress

The FDA’s approval comes as the Trump administration has slashed funding for HIV prevention and treatment programs, both in the U.S. and abroad. Without government support or affordable pricing, lenacapavir’s potential could be wasted.

The Bottom Line: A Major Step Forward—With Major Barriers

Lenacapavir is a scientific breakthrough, offering the most effective HIV prevention tool yet. But unless cost and accessibility issues are resolved, its impact may be limited.

For now, the question remains: Will this drug help end HIV, or will it only be available to those who can afford it?

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