Lenacapavir made up 1% of U.S. PrEP use in the first six months of 2025, study finds | AIDS 2026

In the first six months after the FDA approved a twice-yearly injectable version of lenacapavir for pre-exposure prophylaxis (PrEP) against HIV, the formulation accounted for only about 1% of all PrEP, according to a study presented at AIDS 2026, the 26th International AIDS Conference, being held in July in Rio de Janeiro, Brazil. The researchers also reported that the uptake of lenacapavir for PrEP uptake in the six months after its approval repeated many of the racial, ethnic and age-based disparities seen with older versions of PrEP.

Using the Symphony Health database, Aaron Siegler, M.H.S., Ph.D., a professor of epidemiology at Emory University Rollins School of Public Health, and his colleagues identified prescriptions for lenacapavir PrEP, which is sold under the brand name Yeztugo in the U.S.; cabotegravir PrEP, which is sold under the brand name Apretude; and the two daily pill forms of PrEP that are on the market in the U.S., Truvada (tenofovir disoproxil fumarate and emtricitabine) and Descovy (tenofovir alafenamide/emtricitabine). Generic versions of Truvada and Descovy are on the market.

Using claims as a proxy for users, Siegler and his colleagues identified 7,134 lenacapavir PrEP users from June 1, 2025, through Dec. 31, 2025, which works out to just over 1% of the total 572,880 users. Their tally showed 31,868 cabotegravir users, or approximately 5.5% of the total, and 533,878 oral PrEP users, or a little more than 93%. The FDA approved lenacapavir for PrEP on June 18, 2025, so the relatively small number of lenacapavir users is not surprising. In an email to Managed Healthcare Executive, Siegler notes lenacapavir use is trending upward, though he does not yet have data beyond December 2025. Information from the database used in the study is delivered annually, and 2026 figures will not be available until early 2027. Seigler said he and his colleagues believe that the Symphony database captures between 80% and 90% of PrEP prescriptions but that “closed” health systems, such as Kaiser and the Department of Veteran Affairs, are not included.

The 2025 figures show that lenacapavir users were similar in age and race and ethnicity to users of other PrEP regimens, but there’s a higher share — 15% — of women. In the U.S., women make up a small percentage of PrEP users. According to the data presented by Siegler, women made up just 9% (52,719 out of 572,880) of PrEP users during the June-December 2025 time span that he and his colleagues studied.

Siegler and his colleagues computed a PrEP-to-needs ratio, with need represented by the number of new infections. Notionally, the statistic gets at the issue that PrEP would have the greatest preventive effect if it were used by people in groups with the highest infection rates. Their calculations show that Black persons had 17% of lenacapavir prescriptions per new HIV diagnosis compared with lenacapavir prescriptions per new HIV diagnosis among White persons, and that ratio was just slightly higher—19%—for Hispanic persons.

Medicaid covered 28% of lenacapavir users, more than double the 12% share among oral PrEP users. Siegler and his colleagues wrote that copays exceeding $100 were more common for lenacapavir, affecting 5% of users compared with 1% of oral PrEP users. “Higher LEN [lenacapavir] use by Medicaid users and higher rates of copay [greater than] $100 likely indicate that insurance-related barriers hinder LEN use among commercially insured persons,” they concluded. In his email to MHE, Siegler wrote that it was “informative that within the first year of LEN prescribing, very similar inequities to other PrEP modalities have emerged. This indicates a need for systems changes in addition to medications.”

Siegler noted in this email that there are practical barriers other than insurance coverage and out-of-pocket costs. He and his colleagues, with support from ViiV Healthcare and Gilead Sciences, the developer of lenacapavir PrEP, have created the PrEP Locator website that allows visitors, using their ZIP code, to search for nearby locations where PrEP is available.