Twice-Yearly HIV Prevention
Lenacapavir, injected every six months, prevented almost all HIV infections in trials; the FDA approved it in June 2025 and African rollout began that November.
Open in the interactive tree →Gilead's lenacapavir blocks the HIV capsid and is injected under the skin every six months, instead of a daily pill. In the PURPOSE 1 trial (5,338 women in South Africa and Uganda) no one in the lenacapavir group became infected, against 39 and 16 infections in the two daily-pill groups; in PURPOSE 2 (3,265 men and gender-diverse people) there were 2 infections against 9 on a daily pill. The FDA approved it as Yeztugo on 18 June 2025, and WHO, which counted 1.3 million new HIV infections worldwide in 2024, recommended it on 14 July 2025.
As of October 2026
The first shipments, to Eswatini and Zambia, were announced on 18 November 2025, five months after FDA approval; Gilead pledged to supply up to two million people at no profit until generic makers can meet demand and signed royalty-free licences with six generic manufacturers. By April 2026 more than 11,000 people in eight African countries had started the injection, with over 600,000 starts projected for 2026 (Clinton Health Access Initiative). On 14 April 2026 the US and the Global Fund widened their joint goal to 3 million people through 2028, and cheaper generic versions are expected as early as 2027.
Open steps
- Generic supply at about $40 a year Low AI leverageSix makers hold royalty-free licences and generics are planned at about US$40 a year from 2027, pending approval. Can supply and clinics keep up with demand?
- Resistance after stopping the shot Medium AI leverageDrug levels fall slowly for months after the last injection. An infection in that window could select resistant virus. How should people stop or switch safely?
- Once-yearly injection Low AI leverageA once-a-year intramuscular lenacapavir is in an open-label phase 3 trial measuring drug levels and safety. Whether it protects, and when it is approved, is still open.
- Antibodies plus lenacapavir Medium AI leverageTwice-yearly lenacapavir plus two antibodies kept viral load down for 52 weeks in a small trial. Can antibody regimens lead to HIV control without drugs?
Where AI could help
Low AI leverage. AI can pick who to offer the shot, but price, drug supply and clinics that can inject every six months decide how many are protected.
- Risk models that decide who is offered the injection first
- Forecasting drug demand and stock for each clinic
- Reminders and tracking for the six-monthly return visit
- Mapping where new infections concentrate to place clinics
Shown so far
- In a 2020 study of data from 16 rural communities in Kenya and Uganda, machine learning caught half of new HIV infections by targeting 18% of the population, against 42% when targeting by risk group. source
Prerequisites
Unlocks
- Curing HIVopen
- HIV controlled without drugs2040s?