新型HIV预防药物lenacapavir因其给药方式的便利性而被寄予厚望，但专家警告其实际防控效果面临现实制约。该药物采用每六个月注射一次的方式，相比需要每日服用的传统PrEP口服药物大幅改善了用药依从性1。然而，价格昂贵和分配不均正在限制其在全球范围内的应用潜力。
吉利德与全球基金在2025年7月达成协议，将在三年内向200万人供应该药物，采用无利润模式1。此外，吉利德在2024年10月同意在120个资源有限国家生产廉价仿制药版本1。尽管如此，巴西、墨西哥、秘鲁和阿根廷等拉美国家被排除在最近的供应协议外1。南非计划于2026年6月启动lenacapavir供应计划1。
用药依从性问题突出了这一困境的另一个维度。根据研究人员的观察，PrEP患者在三个月内就有约50%停止服用，年底时仅少数人继续使用1。华盛顿大学流行病学家Monisha Sharma指出，即使在南非、津巴布韦和肯尼亚为2-4%的成年人提供lenacapavir，也只能在十年内阻止12-18%的新感染1。无国界医生组织呼吁吉利德将每针价格降至约40美元1，以扩大药物的可及性。这表明，该药物能否有效控制HIV传播的关键在于能否将其送达最高风险人群。
Lenacapavir, a new HIV prevention drug administered via injection every six months, offers a significant improvement in treatment adherence compared to daily oral PrEP medications.1 However, experts warn that its effectiveness in controlling HIV transmission remains constrained by high costs and unequal distribution globally.1
Under an agreement reached between Gilead and the Global Fund in July 2025, lenacapavir will be supplied to 2 million people over three years at no profit.1 Additionally, Gilead committed in October 2024 to producing affordable generic versions in 120 resource-limited countries.1 Despite these efforts, several Latin American nations—including Brazil, Mexico, Peru, and Argentina—have been excluded from recent supply agreements.1 South Africa is set to launch its lenacapavir supply program in June 2026.1
The real-world impact of expanded access, however, remains modest. According to epidemiologist Monisha Sharma from the University of Washington, even if 2-4% of adults in South Africa, Zimbabwe, and Kenya receive the drug, it would prevent only 12-18% of new infections over a decade.1 A major barrier to effectiveness is adherence: approximately 50% of PrEP patients discontinue use within three months, with only a small percentage continuing by year's end.1 Médecins Sans Frontières has called on Gilead to reduce the price per injection to approximately $40 to improve accessibility and uptake among at-risk populations.1
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