Lenacapavir, The Twice-a-Year Injection For HIV Prevention Isn’t Yet In Nigeria But Will Soon Be

There have been great strides made in the HIV response, with options like oral pills (such as Truvada for pre-exposure prophylaxis, PrEP), Cab-LA (cabotegravir long-acting injection), the Dapivirine ring, and antiretroviral therapies (ART) for prevention and treatment. These tools have saved millions of lives and reduced transmission rates. However, the number of new infections remains high, mainly due to shortcomings like forgetfulness, pill burden, and mental health challenges that make consistent use difficult. The discovery of lenacapavir is one that sets us on a better course, offering a long-acting solution that could overcome these barriers.

So what is lenacapavir?

Lenacapavir (also known as GS-6207) is a first-in-class capsid inhibitor developed for both treating and preventing HIV-1 infection. It's a small molecule drug that targets the HIV virus in a unique way, making it highly effective even against strains resistant to other medications.

Mechanism of Action

To understand how lenacapavir works, think of the HIV virus as a machine that needs a strong outer shell called the capsid to invade and replicate inside human cells. The capsid is made up of about 1,000 to 1,500 protein units arranged in hexamers (six-unit groups). Lenacapavir binds right at the interface between these subunits, disrupting the capsid's structure and function.

This interference happens at multiple stages of the virus's life cycle: it blocks the orderly assembly of new virus particles, prevents the capsid from trafficking properly inside the cell, and stops the virus from releasing its genetic material into the host's nucleus for integration. Because the capsid is highly conserved (it doesn't change much across different HIV strains), lenacapavir shows minimal resistance, making it a promising target unlike some older drugs.

Why It Can Protect for So Long

Lenacapavir's standout feature is its long-acting nature. After subcutaneous injection (under the skin), it has a delayed peak concentration (around 77-84 hours) and an extended elimination half-life of 8-12 weeks. This means the drug releases slowly into the bloodstream, maintaining effective levels for months. Its high potency, combined with low systemic clearance and slow release kinetics, allows just one dose every 26 weeks (about six months) to provide ongoing protection. In prevention trials, this led to near-100% efficacy, far surpassing daily pills, where adherence issues reduce real-world effectiveness.

How It Is Taken

Lenacapavir is administered subcutaneously, typically in the abdomen. There are two starting options before moving to maintenance:

Option 1

Day 1: Subcutaneous injection of 927 mg (two 1.5 mL shots) plus oral 600 mg (two 300 mg tablets). Day 2: Another oral 600 mg. 

Option 2

Days 1-2: Oral 600 mg each day. Day 8: Oral 300 mg. Day 15: Subcutaneous 927 mg. 

Maintenance follows with one 927 mg injection every 26 weeks (±2 weeks). For prevention (PrEP), you need a negative HIV test before each dose. It's simple—no daily routine required.

The Oral Pill Bridge for Lenacapavir PrEP

There are situations where a patient knows in advance they won't be able to return for their next lenacapavir injection on time (e.g., travel, work, or other commitments). In such cases, an oral bridging strategy helps maintain protection during the gap.

- If the scheduled 6-month injection is anticipated to be delayed by more than 2 weeks (i.e., more than 28 weeks since the last injection), oral lenacapavir tablets (300 mg) should be taken once every 7 days as an interim bridge.

- This can continue for up to 6 months if needed, until the injection can be resumed.

- Resume the maintenance subcutaneous injection within 7 days after the last oral dose.

- This bridging keeps drug levels high enough to provide ongoing HIV prevention.

If oral lenacapavir is not available during the bridge period, switch to a standard daily oral PrEP regimen (TAF/FTC like Descovy or TDF/FTC like Truvada generics) until re-initiation of lenacapavir injections.

This is for planned delays only; unplanned missed injections (beyond 28 weeks without bridging) may require restarting the full initiation regimen.

Side Effects

Lenacapavir is generally well-tolerated. The most common issues are injection-site reactions like pain, swelling, redness, or nodules, mostly mild and resolving quickly. In pooled trial data, other frequent side effects include nausea, diarrhea, and headache.

Use for HIV Treatment

Beyond prevention, lenacapavir is approved for treating HIV-1 in heavily treatment-experienced people with multidrug-resistant strains. It's not for standalone use. It is combined with other antiretrovirals in an optimized regimen. Trials like CAPELLA showed it achieved viral suppression (<50 copies/mL RNA) in up to 83% of participants at 52 weeks. Ongoing studies (e.g., CALIBRATE, ARTISTRY) explore it in treatment-naïve or suppressed patients, with promising results for long-term control. A proof-of-concept study with broadly neutralizing antibodies (bNAbs) like teropavimab and zinlirvimab demonstrated safe, durable suppression for at least 26 weeks in people switching from oral ART.

Lenacapavir Discovery

Lenacapavir was developed by Gilead Sciences through a high-throughput screening process. For treatment, it's often referred to as Sunlenca. For prevention (PrEP), the brand is Yeztugo in some markets, but it's commonly known by its generic name, lenacapavir.

Main Cost and How It Is Being Subsidized

In high-income countries like the U.S., lenacapavir costs around $28,000-$42,000 per year, making it unaffordable for many. However, global access deals have slashed this for low- and middle-income countries. Through partnerships with organizations like the Bill & Melinda Gates Foundation, UNITAID, CHAI (Clinton Health Access Initiative), and generic manufacturers (e.g., Dr. Reddy’s Laboratories), the price is set at about $40 per person per year (around ₦58,000 in Nigeria). Subsidies from PEPFAR (U.S. President's Emergency Plan for AIDS Relief) and the Global Fund cover initial rollouts, aiming to reach 2 million people in high-burden countries by 2028. This makes it viable for widespread use in Africa.

Rollout in African Countries

Lenacapavir has already started rolling out in several African countries through donor-supported programs. Zimbabwe launched a national program in February 2026, targeting high-risk groups. Kenya received starter doses in February 2026, with phased rollout in high-burden counties starting March. Eswatini and Zambia began in late 2025, with initial shipments covering thousands. South Africa started its rollout in early 2026, focusing on integration into existing programs. Other countries like Mozambique (approved January 2026), Lesotho, Uganda, and Nigeria are expected soon.

As a community pharmacist in Lagos, I am optimistic about lenacapavir's arrival in Nigeria. It could transform how we prevent and manage HIV. While we wait, stick to available options like daily PrEP and regular testing. Stay informed, and let's keep pushing for access.