An injection that can revolutionize the fight against HIV is the scientific breakthrough of the year according to ‘Science’ magazine

The magazine Science has chosen as the most important scientific advance of 2024 the development of lenacapavir, a new drug to prevent HIV that promises to take a giant step in the fight against the epidemic. The scientific publication equates this leap to that made in the 1990s with antiretrovirals, compounds that allow the viral load to be neutralized until it is undetectable and, therefore, untransmittable.

It is a revolution yet to come. Lenacapavir attacks the viral capsid protein and is already used in developed countries as an antiretroviral in virus resistant paintings that do not respond to other treatments. In other words, like rescue therapy. However, the truly revolutionary potential has only recently been discovered. A trial published before the summer in the journal NEJM revealed that its use every six months, through a long-acting injection, could go further: it is also effective in protecting against infections.

Of the 2,134 young women in South Africa and Uganda who received two annual injections of the drug, none became infected. This use – as pre-exposure prophylaxis – is not approved anywhere in the world, although it is expected to be authorized in 2025. “It has been shown to completely prevent the disease,” recalls the editor-in-chief of Science, Holden Thorp, in an editorial in which he highlights the advantage that it does not have to be taken every day. It is a better option, the magazine maintains, because it boosts adherence and reduces stigma.

The first of a new family

“The award also recognizes work related to gaining a new understanding of the structure and function of the HIV capsid protein. Despite decades of progress, HIV continues to infect more than a million people a year, and the vaccine remains difficult to find,” they argue from the scientific publication to explain their choice.

Josep Mallolas, head of the HIV-AIDS unit at the Hospital Clínic in Barcelona, ​​agrees that “it deserves to be considered the most important medical advance of this year due to the impact it can have on the control of the HIV pandemic.” according to his statements to Science Media Center Spain. The expert frames lenacapavir as the “first of a new family of antiretrovirals that inhibit the formation of the HIV capsid.” This protein capsid, a kind of envelope, protects the genetic material of the virus. How does it work? “By stiffening this protein, the drug blocks key stages of viral replication,” they emphasize. Science. The capsid attack mechanism “was previously considered impractical.” In addition, it could inspire treatments for other viral diseases.

There is a consensus that administering it only twice a year facilitates adherence to treatment, one of the great Trojan horses in the fight against the virus in the world, especially in less developed countries. “This feature is very attractive as a new PreP option,” he points out. in your recommendations the Gesida group of the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc). PreP, acronym for pre-exposure prophylaxis, has been available in Spain within the public health portfolio since 2019 to prevent HIV infection in people at highest risk.

1.5 million people were infected with HIV in 2020 worldwide. The goal, set in the global HIV strategy, is that cases will be reduced to 335,000 in 2030. This means reducing new infections by 80% in just six years, recalls the NGO Salud por Derecho. in this forum published by The Country. Contagion prevention strategies are a priority to get as close as possible to that horizon, experts agree.

Price and inequality

The joy of the discovery of lenacapavir, however, has been clouded by a fact: annual doses cost $42,259 (38,900 euros). Behind its manufacture is the pharmaceutical company Gilead. This frustration was very evident at the last International AIDS Conference held in June in Munich, where groups of different NGOs and activists supported protests to pressure Gilead. In this forum a study was presented that estimates that the antiretroviral could be sold at a price a thousand times lowerfor $40 per patient per year, and maintain a 30% profit.

This problem is not reflected in the editorial, something that organizations such as Salud por Derecho did not like. “At a time when there are treatments and prevention tools such as lenacapavir that can help meet UNAIDS goals, these remain (and will remain if nothing changes) inaccessible to millions of people who need them,” he emphasizes. Adrián Alonso Ruiz, head of Research and Promotion of the NGO in statements to SMC.

The well-founded fear is that this cost will curb its potential to significantly reduce the number of new cases. Organizations such as Salud por Derecho or Doctors Without Borders have been warning about this situation for months, which can further deepen the inequity of access to effective HIV medications. “Global deployment depends on affordability, manufacturing agreements and the strength of healthcare infrastructure, with regulatory approval expected in 2025,” the scientific publication says.

It is not the first time that the magazine Science opt for a milestone related to this virus. He has already done it twice before, the editorial recalls. The first was in 1996, with the development of virus protease inhibitors. These drugs made it possible to leave HIV behind as “a quick killer” and transform it “into a disease that could be treated for many years,” Holden Thorp emphasizes in the publication.

The second occasion came in 2011, when a groundbreaking trial (HPTM 052) “demonstrated that treatment with a cocktail of these compounds not only completely suppresses HIV in infected people, but also substantially reduces the risk of sexually transmitting the virus.” to other people.” More than a decade later, this new advance continues to pave the way towards the vaccine, the pending challenge, and remember, concludes the editorial of Sciencethat “the fight is far from over.”