Innovative treatment offers hope of reaching of ending AIDS by 2030

A groundbreaking medicine presented at the Munich International AIDS conference could be a game changer, but the cost is prohibitive.

At the 25th International AIDS Conference (IAS), held in Munich from 22 to 26 July, over 10,000 doctors, public health experts, and activists from 175 countries attended the world’s largest annual HIV and AIDS conference. 

Despite significant progress in developing preventive drugs and reducing the number of new HIV infections each year from 3.3 million nearly 40 years ago to 1.3 million today, challenges remain.

“We at UNAIDS continue to advocate for ending all inequalities that drive the HIV epidemic and health disparities globally”, said Winnie Byanyima, Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director.

Drivers of the epidemic and disparities include inadequate funding and access, stigmatisation, discrimination and uneven distribution of pharmaceuticals between high- and low-income countries.

New medicine stokes optimism and sparks protest

Significant advances have been made in the treatment of HIV, allowing people to live a good quality of life with appropriate medical care. 

US pharmaceutical giant Gilead’s twice-yearly injectable Lenacapavir showed 100% efficacy in its interim Phase 3 trial for HIV prevention in more than 5,000 cisgender women in South Africa and Uganda, indicating promising advancements in pre-exposure prophylaxis (PrEP).

PrEP is a preventive treatment for people at high risk of HIV infection that is a daily medicine taken orally as a pill. Lenacapavir is a twice-yearly injectable treatment, making it more suitable for vulnerable groups such as sex workers, gay men, trans people, and drug users, who often avoid testing and treatment. 

At a price

An analysis of the cost of producing the active pharmaceutical agreement, carried out by a number of universities and presented by Andrew Hill at the conference, shows that the price of injectable Lenacapavir could be reduced to around $35-40 per patient per year.

The paper argues that this would require voluntary licensing agreements for generic production and guaranteed purchase agreements. 

Lenacapavir is currently licensed for treatment, not prevention, and Gilead sets the cost at $42,250 for the first year. 

Médecins Sans Frontières (MSF) activists at AIDS 2024 called for immediate global action to break Gilead’s monopoly on Lenacapavir.

“100% effectiveness demands 100% access,” said Asia Russell of Health GAP, a global HIV advocacy organisation. “Lenacapavir for HIV prevention is a potentially pandemic-defeating intervention.

Gilead has a long track record of undermining global access by excluding middle-income countries from voluntary licensing deals and artificially restricting licensees.”

Chanting “people over profit” and “Gilead’s greed kills,” activists called on the company to commit to non-exclusive, transparent and geographically inclusive voluntary licensing agreements through the UN-backed Medicines Patent Pool to ensure affordable access.

This development aside, there is much optimism that an mRNA-based vaccine against HIV – a technology that gained momentum during the COVID pandemic – will be available in the not-too-distant future.

Dwindling government focus

According to the UNAIDS 2024 report, increased funding for HIV prevention is leading to a decline in HIV incidence, the regions with the largest funding gaps – Eastern Europe, Central Asia, the Middle East and North Africa – are making the least progress.

In contrast, Central and Western Europe and North America have seen a 24% reduction in new HIV infections and a 34% reduction in AIDS-related deaths since 2010. 

Germany’s Chancellor Olaf Scholz (SPD/S&D), who opened the conference said efforts must be stepped up: “Why is [funding] so important? Because the programmes sponsored by the Global Fund have saved 59 million lives. 59 million! This number speaks for itself”.

In a similar vein, Byanyima, emphasised the urgency:  “World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected”.

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