Mitchell Warren on weekly islatravir-lenacapavir for HIV treatment | AIDS 2026

Positive results from two phase 3 trials, ISLEND-1 and ISLEND-2, testing a once-weekly combination pill are looking to be one of the standout findings presented at AIDS 2026, the 26th International AIDS Conference in Rio de Janeiro, Brazil. The once-weekly combination pairs oral lenacapavir, from Gilead Sciences, with islatravir, from Merck — a partnership between two companies that are typically competitors in HIV therapeutics. Researchers reported the results at a press conference last week in advance of the AIDS 2026 meeting that is scheduled to start tomorrow.

In this interview with Managed Healthcare Executive, Mitchell Warren, the longtime executive director of AVAC, discusses what a shift to less frequent oral dosing could mean for HIV treatment programs operating with shrinking budgets. He noted that a weekly pill is a smaller step than the monthly or longer-interval injectables often described as "long-acting" but said it still matters for people who have taken a daily pill for years. How the pill will be priced and how soon generic manufacturers will be able to make it are works in progress, Warren said, but a regimen of 52 annual doses instead of 365 could lower overall drug costs even if each pill costs more and could help accelerate different models of service delivery.

"If we can move people to weekly oral, and then eventually monthly dosing, or even bi-monthly or every six-month dosing, we may be able to do more with less. We can have more impact, get more people on treatment when the drugs cost less and when they go to the clinic less often," he said, pointing to funding constraints stemming from cuts to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria running behind on its replenishment goals as well as the broader global economy.

Warren compared the shift to earlier moves toward fixed-dose combination pills, which replaced multipill antiretroviral regimens and proved cheaper to procure and easier for patients to take. "This innovation is an efficiency gain, both on the product procurement side and on the programmatic side, so it is hugely opportune," he said, adding that he hopes future HIV treatments will move to even longer dosing intervals than weekly.