Lenacapavir: The $40 Breakthrough Drug Changing the Fight Against HIV

Lenacapavir is being described as one of the most promising tools in the fight against HIV. Known by brand names such as Yeztugo (for prevention) and Sunlenca (for treatment), it belongs to a new class of HIV drugs called capsid inhibitors. Unlike current daily pills, lenacapavir is adminsited as an injection only twice a year. For South Africa, where HIV continues to affect millions, this development could be transformative.

Why Lenacapavir Matters

The HIV capsid is the protective shell around the virus. Lenacapavir works by blocking this shell’s ability to function properly at different stages of the virus’s life cycle. Because targets multiple stages of the virus’s life cycle, it remains effective against HIV strains resistant to other medicines.

Globally, lenacapavir has already been approved for people with multidrug-resistant HIV-1, but it has the potential to be better than pre-exposure prophylaxis (PrEP). In July 2025, the World Health Organization (WHO) recommended lenacapavir as a new HIV prevention option.

Clinical Results Show Positive Results 

Trials have shown extraordinary results. In one test, cisgender women who received lenacapavir had zero new HIV infections. In another trial, involving cisgender men, transgender, and gender-diverse participants, infection rates dropped by about 96% compared to background levels.

Across both trials, over 99.9 % of participants receiving lenacapavir stayed HIV negative. A large comparison also confirmed that the injection was more effective than the daily pill Truvada.

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South Africa’s HIV Challenge

About 7.8 million South Africans, roughly 12.7 % of the population live with HIV. Each year, more than 200,000 new infections are recorded, with young women and girls leading the way.

Daily PrEP pills come with challenges such as stigma, long clinic visits, and costs. A twice-yearly injection could remove these problems.

When Will It Arrive ?

The  government has signaled interest in rolling out lenacapavir at more than 300 public clinics between 2026 and 2028, especially in high-burden districts. Before that, it needs approval from SAHPRA (South African Health Products Regulatory Authority) and inclusion on the Essential Medicines List, which allows public procurement.

Funding is also a factor. The Global Fund has already budgeted around R513 million to help South Africa secure supplies, even before generics hit the market.

The $40 Breakthrough

In the United States, branded lenacapavir can cost up to USD 28,000 per year, which is expensive for many people. But in September 2025, a global deal was struck that will allow lenacapavir to be available for just USD 40 (about R730) per year across low and middle-income countries, starting in 2027.

This price is lower than what South Africa currently spends on daily PrEP pills, which cost about R629 per person annually . If the country is included in the deal, the cost barrier that has long slowed new HIV technologies could finally be overcome.

Challenges Ahead

Many are looking towards  SAHPRA and other policy bodies to give the greenlight for its use. Clinics will need to adapt by managing injections and tracking patients. Communities need to be educated about the injection and its benefits.

The Bottom Line

Lenacapavir offers a opportunity to reshape the global fight against HIV. With near-100% protection in trials and a plan to bring the price to $40 per year, this is a welcome development.

As HIV continues to affect millions of lives, lenacapavir could become the tool that turns the tide. The next few years are crucial as this breakthrough is expected to change millions of lives.