新型HIV预防药物lenacapavir因其给药方式的便利性而被寄予厚望，但专家警告其实际防控效果面临现实制约。该药物采用每六个月注射一次的方式，相比需要每日服用的传统PrEP口服药物大幅改善了用药依从性[1]。然而，价格昂贵和分配不均正在限制其在全球范围内的应用潜力。
吉利德与全球基金在2025年7月达成协议，将在三年内向200万人供应该药物，采用无利润模式[1]。此外，吉利德在2024年10月同意在120个资源有限国家生产廉价仿制药版本[1]。尽管如此，巴西、墨西哥、秘鲁和阿根廷等拉美国家被排除在最近的供应协议外[1]。南非计划于2026年6月启动lenacapavir供应计划[1]。
用药依从性问题突出了这一困境的另一个维度。根据研究人员的观察，PrEP患者在三个月内就有约50%停止服用，年底时仅少数人继续使用[1]。华盛顿大学流行病学家Monisha Sharma指出，即使在南非、津巴布韦和肯尼亚为2-4%的成年人提供lenacapavir，也只能在十年内阻止12-18%的新感染[1]。无国界医生组织呼吁吉利德将每针价格降至约40美元[1]，以扩大药物的可及性。这表明，该药物能否有效控制HIV传播的关键在于能否将其送达最高风险人群。
Lenacapavir, a new HIV prevention drug administered via injection every six months, offers a significant improvement in treatment adherence compared to daily oral PrEP medications.[1] However, experts warn that its effectiveness in controlling HIV transmission remains constrained by high costs and unequal distribution globally.[1]
Under an agreement reached between Gilead and the Global Fund in July 2025, lenacapavir will be supplied to 2 million people over three years at no profit.[1] Additionally, Gilead committed in October 2024 to producing affordable generic versions in 120 resource-limited countries.[1] Despite these efforts, several Latin American nations—including Brazil, Mexico, Peru, and Argentina—have been excluded from recent supply agreements.[1] South Africa is set to launch its lenacapavir supply program in June 2026.[1]
The real-world impact of expanded access, however, remains modest. According to epidemiologist Monisha Sharma from the University of Washington, even if 2-4% of adults in South Africa, Zimbabwe, and Kenya receive the drug, it would prevent only 12-18% of new infections over a decade.[1] A major barrier to effectiveness is adherence: approximately 50% of PrEP patients discontinue use within three months, with only a small percentage continuing by year's end.[1] Médecins Sans Frontières has called on Gilead to reduce the price per injection to approximately $40 to improve accessibility and uptake among at-risk populations.[1]