Lenacapavir is a long-acting antiretroviral drug developed by Gilead Sciences for the treatment and prevention of HIV-1 infection.

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What is it?

Mechanism: Lenacapavir is a capsid inhibitor – it targets the HIV-1 capsid protein, essential for viral replication, assembly, and disassembly.

Form: It is available as oral and injectable formulations.

Duration: One injection can last up to 6 months, offering convenience and long-acting protection.

Benefits

For treatment:

• Used in heavily treatment-experienced patients with multi-drug resistant HIV
• Helps suppress viral load effectively when combined with other ART

For prevention (PrEP):

• Being tested as a long-acting PrEP, especially for populations with adherence challenges to daily pills

Effectiveness

Clinical trials like CAPELLA have shown:

• 81% virologic suppression at 52 weeks in patients with multidrug resistance
• Studies for its PrEP role (e.g., PURPOSE trials) are ongoing and show promising results

PRE-EXPOSURE PROPHYLAXIS (PrEP)

What is PrEP?

• PrEP involves taking medication before potential HIV exposure to prevent infection
• It is meant for HIV-negative people at high risk (e.g., sex workers, MSM, serodiscordant couples)

Medications used

Most common: Tenofovir disoproxil fumarate (TDF) + Emtricitabine (FTC) – sold as Truvada.

Now includes long-acting injectables like cabotegravir and investigational drugs like Lenacapavir.

How does PrEP work?

• It prevents HIV from establishing infection in the body by inhibiting reverse transcriptase (in case of TDF/FTC)
• Needs to be taken daily or as per protocol to maintain efficacy

Use in India

• Introduced in select high-risk populations via National AIDS Control Organisation (NACO)
• In 2021, NACO piloted oral PrEP programs in select cities
• Greater emphasis is now being laid on scaling up PrEP awareness and introducing long-acting options in public health systems

HIV – Causes, prevention, and management

CAUSES

Caused by Human Immunodeficiency Virus (HIV)

Spreads through: Unprotected sexual contact; blood transfusion (if unscreened); sharing infected needles; from mother to child (during childbirth or breastfeeding)

PREVENTION

• Safe sex practices – condoms
• PrEP and PEP (Post-exposure prophylaxis)
• Voluntary Testing and Counselling
• Safe blood supply and sterile needle programs
• ART during pregnancy to prevent mother-to-child transmission

CURE/TREATMENT

No definitive cure yet

Controlled with Antiretroviral Therapy (ART):

• Suppresses viral load
• Restores immune function
• Improves life expectancy and quality of life
• Research ongoing in gene editing, vaccines, and immunotherapy for a possible cure

Civil Services exam point of view

Short questions

1. What is Lenacapavir and how does it function?
2. What is the role of PrEP in HIV prevention?
3. Name two commonly used drugs for PrEP.

Long questions

1. Discuss the mechanism, benefits, and challenges of Lenacapavir in HIV treatment and prevention.
2. Explain the concept of Pre-Exposure Prophylaxis (PrEP) and its role in India’s HIV prevention strategy.
3. Write a note on the causes, prevention, and treatment of HIV/AIDS in India.

Analytical Questions

1. Do you think India should invest in long-acting PrEP medications like Lenacapavir as part of its public health program? Justify your view with global and national evidence.
2. “HIV/AIDS is more of a social disease than a medical one.” Discuss in the context of stigma, access to care, and preventive measures in India.
3. Evaluate the National AIDS Control Programme (NACP) in India. How can it be made more effective in the era of long-acting ART and PrEP?

Key points box (for revision)

Topic              Key points

Lenacapavir:    Long-acting HIV drug for resistant cases and PrEP trials ongoing

PrEP:               Daily or injectable preventive medication for high-risk HIV-negative

HIV causes:    Unprotected sex, blood contact, needle sharing, mother-to-child

Prevention:      Condoms, PrEP, awareness, safe blood/needles, ART in pregnancy

Treatment:       ART – lifelong; no permanent cure yet

India focus:     NACO’s PrEP pilot, scaling up ART, stigma reduction needed