Josep Mallolas

Science magazine has named lenacapavir as breakthrough of the year. Lenacapavir is an injectable drug that prevents HIV infection for six months with near 100% efficacy. The publication notes its potential to dramatically reduce infections in high-risk populations, but also reminds that global roll-out will depend on affordability, manufacturing agreements and a robust health infrastructure. Approval of the drug is expected by 2025. 

The Science group is simultaneously publishing four papers (two in the journal Science, one in Science Immunology and one in Science Translational Medicine) that include advances in a sequential vaccination strategy for an effective HIV vaccine. The methods employed aim to obtain broad-spectrum neutralising antibodies and one of the proposals is already in clinical trials. 

Pre-exposure prophylaxis (PrEP), which usually consists of taking a daily oral anti-HIV drug, is a highly effective measure to prevent HIV infection. However, it only works well if people strictly follow the protocol, and some people end up not adhering to it. To improve this situation, researchers have tested an implant under the skin of non-human primates that releases the antiretroviral drug islatravir and maintains adequate concentrations for at least 20 months. The results, published in the journal Science Translational Medicine, show complete protection against infection with repeated exposure.

A virological and immunological follow-up confirms that a third patient has been cured of HIV nine years after receiving a bone marrow transplant for myeloid leukaemia, and four years after stopping his antiretroviral treatment. This case of the Düsseldorf patient, similar to two previously documented in Berlin and London, is detailed in a Nature Medicine publication by an international consortium coordinated by the IrsiCaixa AIDS Research Institute and the University Medical Center in Utrecht, the Netherlands. The patient was diagnosed with HIV in 2008 and in 2011 with leukaemia, for which he received the transplant in 2013.