A new long-acting injectable HIV drug, lenacapavir, has shown promising results in preventing HIV infection in various trials. However, its availability to low- and middle-income countries is a concern due to restrictions on access.
Lenacapavir, which is already approved as a treatment for HIV in the US, offers almost complete protection against HIV when administered twice yearly through an injection. In phase 3 trials, 100% of women aged 16-25 years in South Africa and Uganda who received lenacapavir were protected against HIV.
The drug’s manufacturer, Gilead, has announced a deal with six manufacturers to produce generic versions in 120 low- and middle-income countries, but experts argue that the regions where most new infections occur are being left behind. Eastern Europe and Central Asia, including Russia, Serbia, and Bulgaria, will not receive the drug under this initial agreement.
Forty-one percent of new HIV infections occur in upper-middle income countries, which could widen the access gap to care and delay the end of the AIDS epidemic. The lack of political will and public awareness in these regions is a major factor, according to experts.
The UNAIDS report “The Urgency of Now: AIDS at a Crossroads” found that new HIV infections in Eastern Europe and Central Asia increased by 20% between 2010 and 2023, with unsafe drug injecting practices being a key factor. The region’s epidemic is largely driven by stigma, discrimination, and punitive laws that prevent access to prevention services.
The funding challenge is significant, as domestic funding may be limited due to competing government priorities, while many countries are classified as upper-middle or high-income, restricting their eligibility for international funding. Some countries will have to pay full price for the drug or issue a compulsory license, which overrides intellectual property protections.
Experts emphasize the need for equal access to lenacapavir and other HIV prevention services in low- and middle-income countries. The Alliance for Public Health, one of the largest NGOs in Ukraine, welcomes the inclusion of Ukraine in the deal but calls for further action to ensure universal access.
Source: https://www.medscape.com/viewarticle/hiv-game-changer-drug-eastern-europe-missing-out-2024a1000m39