THE PRICE OF LIFE

GILEAD SCIENCES, THE LEADER IN HIV MEDICATIONS, HAS DEVELOPED A NEW DRUG THAT COULD EFFECTIVELY END THE DISEASE. BUT NOT ALL PATIENTS SEE THE COMPANY AS A HERO.

- Adam Bluestein

FOUR DECADES AFTER THE HUMAN IMMUNODEFIciency virus was first identified, the end of the epidemic could be in sight. Thanks to treatments and preventive medications, new infections worldwide have fallen dramatically, from 3.3 million at their peak in 1995 to 1.3 million in 2023. Now, with the arrival of a groundbreaking drug from Gilead Sciences, there's serious talk about bringing new cases down to zero.

Foster City, California-based Gilead is already the leader in HIV prevention. Its daily oral pill Descovy accounts for about 40% of the U.S. market for pre-exposure drugs, known as PrEP (pre-exposure prophylaxis). Sales of the company's portfolio of drugs for HIV prevention and treatment reached $19.6 billion in 2024. Some 75% of the nearly 40 million people worldwide who live with HIV receive a Gilead-branded drug or a generic version, according to the company.

But the twice-a-year injectable lenacapavir, which is on track for a June approval as PrEP by the U.S. Food and Drug Administration, has the potential to be a game changer. The first study of lenacapavir to prevent HIV infections, which included more than 5,000 women, showed it to be 100% effective—the first Phase 3 HIV-prevention trial ever with zero infections. In a subsequent study of more than 3,000 men, transgender people, and nonbinary individuals who had sex with male partners, lenacapavir reduced new HIV infections by 96% compared to background incidence.

“A twice-yearly injection to prevent the infection could change everything,” says Gilead CEO Daniel O'Day, “putting an end to the epidemic and all the health and economic challenges that come with it.” According to one estimate, lenacapavir could avert up to a third of HIV infections in eastern and southern Africa over 10 years, if priced affordably enough. Gilead has trumpeted plans for the rollout of lenacapavir in lowand middle-income countries.