HIV: Breakthrough study raises hopes of effective prevention if drug’s cost can be lowered

Landmark results in an African trial of HIV prevention through twice yearly injection could finally break the cycle of mass infection in sub-Saharan Africa, leaders of the United Nations’ HIV/AIDS programme (UNAIDS) have said. But they warned that this could occur only if the prices currently foreseen for such treatments in the west are lowered by hundreds of times.

“The cost of the new long-acting injectable pre-exposure prophylaxis (PrEP) options, and the speed with which they are made available to the people who would benefit the most, will be decisive,” said this year’s report from UNAIDS.1

The potential of one such injectable antiretroviral, lenacapavir, has been highlighted by the results of its first trial as a preventive treatment, among adolescent girls and young women in South Africa and Uganda.2 Participants were randomly assigned to receive either lenacapavir by injection every six months or one of two common oral antiretroviral preventive treatments: F/TAF or F/TDF, commercially known as Descovy and its predecessor, Truvada. All three drugs are made by Gilead Sciences.

The results, published in the New England Journal of Medicine,2 showed that among 5338 participants 55 new HIV infections were observed, all occurring in the two oral treatment groups. A standout finding was zero new infections in the injected participants (0 per 100 person years (95% confidence interval 0.00 to 0.19)), which …