– Dr Andrew Hill
In this Q&A, Dr Andrew Hill (University of Liverpool, Liverpool, UK) discusses new findings from the updated analysis of lenacapavir manufacturing costs, pricing disparities and real-world barriers to global implementation.
He reflects on how six-monthly pre-exposure prophylaxis (PrEP) could reshape adherence, access and cost-effectiveness across different health systems, and shares broader insights on HIV prevention and policy challenges highlighted at IDWeek 2025 in the session: Generic Lenacapavir HIV Pre-Exposure Prophylaxis could be Produced for $25 Per Person Per Year.
Lenacapavir is the closest we have ever been to an HIV vaccine: a six-monthly injection providing close to 100% protection from HIV infection. Lenacapavir is being sold in the USA for US$28,000 per person-year. In Africa, lenacapavir is now available for US$60 per year, and we have calculated that it could be mass-produced for only US$25 per person-year.
In the USA, the extremely high price of lenacapavir could be a barrier to access. CVS Pharmacy has already refused to add lenacapavir to its list of available drugs because of the high price. Sales of lenacapavir since launch have been very low. In low-income countries, cuts in US funding are likely to lead to increases in HIV infections. It is unlikely that the introduction of lenacapavir alone will reverse this damage unless supplies are expanded substantially.
Lenacapavir needs to be provided to people at the highest risk of HIV infection. These include key populations such as commercial sex workers, men who have sex with men, people who use injecting drugs and transgender people.
However, the current US government has cut outreach testing programmes that support these populations, both in the USA and in low-income countries. This makes it much more difficult to reach the people who need protection from HIV infection with drugs such as lenacapavir. The HIV epidemic in the USA is likely to grow in 2025 as a result of these funding cuts.
Lenacapavir is a six-monthly injection, and it could soon be reformulated so that only once-yearly injections are needed. Studies have shown poor adherence to daily oral PrEP among adolescent girls and young women, while adherence tends to be much better among men who have sex with men. Lenacapavir should therefore improve adherence in some populations.
The cost-effectiveness of lenacapavir depends on the price charged by Gilead. In the USA, a price of US$28,000 per year could prevent widespread use, allowing the HIV epidemic to continue to grow. It is more cost-effective to offer oral generic Truvada (tenofovir/emtricitabine), priced at US$500 per year, which can be provided to far more people within limited budgets. The price of lenacapavir would need to fall to around US$2,000 per year to be cost-effective as PrEP.
The year 2025 has been disappointing for medicine as a result of cuts in US government funding, and this was reflected in several of the presentations. Clinical trials have had to be stopped, prevention programmes cancelled and vaccination campaigns questioned at the highest levels. We are likely to see serious damage as a result of these health policies. This overshadowed the IDWeek conference, and many key US healthcare staff were unable to attend because of funding cuts.
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This content has been developed independently by Touch Medical Media for touchINFECTIOUS DISEASES. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Session: Hill A. Generic Lenacapavir HIV Pre-Exposure Prophylaxis could be Produced for $25 Per Person Per Year. Oral presentation #174. IDWeek 2025.
Editor: Katey Gabrysch, Editorial Director.
Disclosures: This short article was prepared by touchINFECTIOUS DISEASES in collaboration with Andrew Hill. The content was developed and edited by human editors. No fees or funding were associated with its publication. touchINFECTIOUS DISEASES utilize AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat).
Andrew Hill discloses he has received grant/research support from UNITAID, and World Health Organisation.
Cite: Andrew Hill. Sustainable HIV prevention in 2025: New strategies for PrEP delivery in a shifting funding landscape. touchINFECTIOUS DISESAES. 20 November 2025.
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