The Need for Lenacapavir Compulsory Licences in Ending the HIV Epidemic

Abstract

In total, 1.3 million people acquired human immunodeficiency virus (HIV) in 2023, well behind the UNAIDS goal of <370 000 infections by 2025. Novel 6-monthly injectable pre-exposure prophylaxis (PrEP) medication lenacapavir is highly efficacious and could be epidemic-changing. However, without equitable access infection rates will continue. Gilead Sciences, the originator, currently charges over $40 000 per person-year for lenacapavir as HIV treatment, far exceeding PrEP cost-effectiveness thresholds, even in the richest countries. Yet the projected cost of production at scale is