Canada’s HIV prevention landscape is poised for a transformation. Lenacapavir, a first-in-class drug intended to prevent the transmission of the virus, may soon be coming into the country. Lenacapavir is given as an injection into the skin of the stomach area (abdomen). It presents a suitable replacement for everyday pill regimens, and U.S. public health officials have recently acknowledged its greater effectiveness.
Lenacapavir is administered as a twice-yearly injection. This forms a local “depot” of medicine that slowly seeps into the patient’s system. This new treatment rollout means that people can now access treatment just twice a year. This switch dramatically reduces the number of medical visits, compared to a regimen requiring the ingestion of daily pills. Clinical trials show that Lenacapavir is less burdensome and more effective than daily oral PrEP (pre-exposure prophylaxis). This significant breakthrough represents the most promising HIV prevention strategy yet.
U.S. Food and Drug Administration (FDA) has already approved Lenacapavir, which is made by Gilead Sciences. The list price—for the drug in the United States is about US$28 218 a year. Canada is looking forward to its first evaluation, coming up in 2019. While Health Canada has committed to completing its review of Lenacapavir by mid-2026, advocates are hopeful it may become available as soon as next year.
Experts are hailing Lenacapavir as a “wonder drug,” pointing to its potential to cut new HIV infections in half. Peter Newman, a social work professor at the University of Toronto, describes the drug as “absolutely a monumental advance in prevention.” He was particularly excited about how the introduction of Lenacapavir could help increase access to effective HIV prevention methods.
Apart from its medical advantages, underlining Lenacapavir’s injection schedule provides pragmatic advantages. Sean Hosein, a science and medicines editor at CATIE, has written about the advantages of less frequent injections. This new policy reduces the amount of time patients are seated in waiting rooms by hours. This increased efficiency may improve compliance with treatment and overall patient experience.
Lenacapavir, an injectable medication, is much more difficult to forget than a daily pill, explained nurse practitioner Patrick O’Byrne. He states, “It’s hard to mess it up. You can get your injection and it works.” This dependability can be extremely helpful in motivating people to maintain their oral PrEP regimen.
Even though Lenacapavir has a lot of benefits, cost is still a big hurdle to overcome. Many people might be discouraged from even having a conversation about PrEP because of the real or imagined costs tied to their access to PrEP. Our own experts have made it abundantly clear that overcoming these high upfront costs is critical to achieving mass adoption. One unnamed source noted, “I think the biggest thing that people say when we talk about PrEP, it’s how much does it cost.”
Lenacapavir’s potential impact goes way beyond its medical efficacy. It marks a significant shift in the public health approach to lowering rates of HIV transmission. Newman argues that providing these COVID-era preventative measures will save money in the long run by preventing new cases of HIV from developing. “These kinds of things could really help to get it out there quicker and it’s certainly cost-effective in the long run because you’re going to prevent a lot of cases of new HIV,” he stated.
With Canada soon to make a decision on Lenacapavir, health experts are calling for access to this new class of treatment to be available. They recommend empowering a broader healthcare workforce—including physicians, nurses, nurse practitioners, and pharmacists—to prescribe and administer Lenacapavir.
