A groundbreaking HIV treatment, Lenacapavir, has been hailed as the breakthrough medicine of 2024. However, its potential to end the HIV epidemic is under threat due to US budget constraints.
Lenacapavir, a twice-yearly injection that prevents HIV transmission, was named the breakthrough medicine of 2024. This game-changer has the potential to end the HIV epidemic, but its delivery to millions worldwide is under threat due to US funding cuts.
HIV treatment has made significant progress since its inception.
Antiretroviral therapy (ART) is the standard treatment, which involves a combination of medications to suppress the virus.
ART can reduce viral loads to undetectable levels, allowing people with HIV to live long and healthy lives.
According to the WHO, ART can prevent 95% of HIV transmissions.
Additionally, pre-exposure prophylaxis (PrEP) is available for those at high risk of infection.
Research continues to explore new treatments and potential cures.
For decades, scientists have been searching for a solution to the HIV epidemic. The elusive vaccine that could block the ongoing chain of infections still sees more than 1 million people worldwide contract the virus annually. However, Lenacapavir has shown promise in preventing sexual transmission of HIV with ‘100 percent efficacy’ by disrupting the function of the virus’s capsid protein.
Despite its effectiveness, access to lenacapavir is a significant challenge. The US government‘s global HIV/AIDS program, PEPFAR, had pledged to procure 2 million doses over three years, but with President Donald Trump‘s decision to freeze all foreign aid funding, this plan has been left in tatters.
The loss of PEPFAR funding for prevention represents a major setback in the world’s ability to control HIV. According to Kenneth Ngure, an HIV-prevention expert in Kenya and president-elect of the International AIDS Society, even if The Global Fund partners with others, they will probably not be able to reach the number of doses they had promised.
Launched in 2003, PEPFAR is a US government initiative to combat HIV/AIDS globally.
Administered by the US Department of State, it focuses on prevention, treatment, and care services.
PEPFAR has invested over $70 billion since its inception, supporting antiretroviral therapy for millions and reducing AIDS-related deaths.
The program also emphasizes tuberculosis and malaria control, as well as maternal and child health initiatives.
The major limitation of PrEP is that adherence is notoriously poor. Long-acting injectables have long been viewed as a better way forward, and in 2021, the HIV field was galvanized by promising trial results for cabotegravir, a form of injectable PrEP that only needed to be administered every two months. However, access has been the major hurdle.
With PEPFAR seemingly now focused primarily on the treatment of existing patients, at the expense of prevention, clinicians are concerned that the infection rate will begin to rise rather than fall. Research is increasingly showing that people living with long-term HIV infections, even those controlled by antiretroviral treatment, are at a greater risk of developing metabolic conditions such as hypertension, obesity, and type 2 diabetes.
It’s not just PEPFAR; we’re also worried about restrictions being placed on other sorts of research funding, such as the National Institutes of Health. It’s just going to get harder to innovate and move progress forward. African countries need to become capable of funding more preventative efforts themselves. Somehow Africa needs to step up and contribute to the fight.
It’s incredible that this has happened just as we’ve had the breakthrough. I think this is going to set us back many years and ultimately cost a lot more in public health spending. Because ultimately, if we can bring this epidemic under control more quickly, it’s going to save the planet more money in the long run, and save lives too.
Lenacapavir is a novel HIV inhibitor that targets the viral protease.
It was developed by Gilead Sciences and has shown promising results in clinical trials.
Lenacapavir works by binding to the viral protease, preventing it from processing viral proteins.
This leads to the inhibition of viral replication and the reduction of HIV-1 RNA levels.
In 2022, lenacapavir received FDA approval for the treatment of HIV-1 infection in adults who have been treated with other antiretroviral therapies.
