How effective is lenacapavir?

Why this medication could be the next best thing to an HIV vaccine

- DR. EDSEL MAURICE T. SALVANA

Last week, the World Health Organization (WHO) issued guidelines on what has got to be the most awaited HIV prevention drug in recent years. Lenacapavir, a long-acting type of antiretroviral medication, is now recommended by the WHO for the prevention of HIV infection in highly exposed individuals. What makes lenacapavir stand out compared to other forms of pre-exposure prophylaxis (PrEP) is that it only needs to be given twice a year. In pivotal clinical trials done over three years, lenacapavir prevented HIV infection in 100 percent of women and 96 percent of men. I wrote about this drug last year, and while there was a lot of excitement then, there were also a lot of questions about feasibility, cost, and safety. Since then, many of these questions have been answered, and the cost is projected to be very reasonable for low and lower-middle-income countries.

In the past, HIV prevention has heavily focused on nonpharmacologic interventions due to the lack of effective vaccines and prophylactic medication. The “ABCDEs” of HIV prevention were all that we had: A for abstinence, B for be faithful, C for condoms, D for don’t do (illicit IV) drugs, and E for education. PrEP or the use of antiretrovirals for preventing HIV infection, was conceived as an additional means of prevention since infections continued to occur among highly exposed individuals. PrEP has had a long history of ups and downs, and many countries have struggled to implement it.