The Current - This new drug could be a game-changer for HIV/AIDS

Episode Date: December 5, 2025

We are bringing you some actually good news and a new drug that is showing incredible promise in fighting HIV/AIDS. It's called lenacapavir. It's not available in Canada yet, but it's getting its first real-world test in three African countries. We talk to Dr Darrell Tan, a leading Canadian HIV prevention researcher about the promise of lenacapavir, and why Canadian doctors should be doing more to make sure HIV prevention drugs get to the people who need them most. And Dr Catherine Martin, a senior researcher with Wits Reproductive Health and HIV in Johannesburg.

This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always over-delivers. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much with so little. You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing.

Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. Imagine a world where HIV and AIDS have been eliminated. Since 1980, this disease has killed more than 44 million people around the globe. There has been significant progress in treating it, but hundreds of thousands of people still die from the virus every year. This week, though, there is new hope.

A new preventative treatment for HIV is rolling out across, several African countries, and a study shows that it has a 100% efficacy rate in preventing HIV infection. Lennacapavir, or Len, has approved in the United States, currently being reviewed by Health Canada. Dr. Daryl Tan is an infectious disease physician at St. Michael's Hospital in Toronto, holds Canada Research Chair in HIV Prevention, and he is with me in studio. Dr. Tan, good morning. Good morning. This has been called a wonder drug. Many things are called wonder drugs, how big of a deal is this drug? Yeah, I think it's a huge deal. It can sound a bit trite to call it that, but I think the fact that we've got a drug that could be administered by

injection every six months, which is just twice a year, and prevent HIV with virtually 100% efficacy, and to do so safely, I think it truly, truly is groundbreaking. When you first saw the results of that study that I quoted saying that there was close to a 100% efficacy rate, what went through your mind? Well, I was at the first. the conference where those results were first presented live, actually, a couple of years ago. And I stood up like the rest of the audience did and gave a standing ovation. That's what happened. That's literally what happened. It doesn't happen that often at that scientific conferences that people get up on their feet and cheer, but that's exactly what happened at the meeting because,

you know, we've been dealing with this epidemic, as you said now, for 45 plus years. We've seen small gains here and there. We certainly are doing amazingly well with treatment. But to be able to prevent this lifelong incurable and heavily stigmatized infection with this much safety and efficacy is just amazing. We've got some interventions that can already do that to some extent, but to do so with such ease, I think is really, really tremendous. So explain what this drug is and how it works. Sure. So the drug's name is Lenocapivir, and the way that it works is it's what we call a capsid inhibitor, which is a very scientific term that just refers to the specific step or actually a number of steps in the life cycle of the virus as it tries to infect a cell and replicate itself to cause

more infection. And in so doing, we're able to block the virus from replicating, infecting new cells and ultimately causing a new infection, even if the virus has entered the body of someone who's HIV-negative and therefore susceptible. So we call this strategy, you know, the use of a drug by someone who's HIV-negative in order to prevent acquisition of HIV. We call that pre-exposure prophylaxis or prep. And as I mentioned, there's some other drugs that are already available that we actually have here in Canada that we're using. But this is a new modality and something that could be used just twice a year is just really groundbreaking. Can you explain what's different? I mean, people may have seen them use those drugs. They don't have seen they're well advertised

as well, prep drugs across this country in some communities at certain times of the year. What's different about these drugs, about this drug than those drugs? Yeah. So, I mean, from a molecular standpoint, which is maybe of less interest to the average person, it simply works at a different stage in the life cycle. But for the average person, I think the meaningful difference is how it's given. You know, the interventions that we got presently in Canada for PrEP include a pill that you can take daily. It includes for some settings, notably sexual minority men, gay by sexual other men of sex with men, a pill that could be taken what we call on demand just around the time of sexual exposure. And we actually do have another long

acting injectable formulation right now. It's another drug called Cabotegavir that's injected every two months that already is radically different because it requires people to, you know, not have to take pills regularly, remember to take them, etc. This drug is given, again, as an injection. It's actually a subcutaneous injection. So the weight's administer is slightly different from the cabotegavere. But regardless, the key innovation is that it's got such a long half-life, which is the term

we give to, you know, how long a drug lasts in the body after its dose, that it can be given every six months. And in fact, there's some exciting science coming down the pipeline suggesting that another formulation of the same drug could potentially in the future be given once a year, you know, and to think of doing something that rarely and then achieve this long-lasting benefit of safe and effective HIV prevention without requiring other action is just amazing. This drug has been, as I said, approved in the United States. We're going to hear more about how it's being rolled out in a number of African countries. Being reviewed by Health Canada now, we asked them when a decision might come and they said they couldn't say.

So if this drug is a game changer, why are you concerned that it's taking so long to arrive here? You know, I've got faith in our regulatory apparatus here in Canada. Their job is to carefully review the science, critically review every piece of documentation that they're provided by a drug company. I think Canadians should be pleased that we have a rigorous review process. Does it take a little longer than we would like, sure, maybe that happens to, some extent, but I think it's a matter of Health Canada doing a careful and thorough job ensuring that a drug they are going to say and ratify, you know, this deserves regulatory approval because it's safe enough and effective enough for our populations. I think that's a

reasonable thing for them to do. In the meantime, certainly, I think, given that we know that this is coming, I think it gives us some time to prepare, which is good. It gives us time to to spread the word through, you know, conversations like this one today. It gives clinicians and health care systems time to think carefully about how we would actually roll this out because it does require health systems to take action in different ways than, you know, simply writing a prescription for a pill does for other medications. If and when it does become available in Canada, who should consider taking it? Well, I think in our, you know, I'll mention that in the guideline that myself and others have

recently published on HIV preins post-exposure prophylaxis this year on World AIDS Day a few days ago, we make the point that, you know, anyone who engages in sexual activity, which is, you know, frankly, most adults, as well as people who might use injection drugs, be at least aware of this. You know, I think it's important that health care providers, that health systems talk to people, raise awareness about tools that, you know, we have that are safe and effective. You know, who will actually choose to take it up is going to vary, and it's largely going to depend on people realizing that, yeah, they do sometimes find themselves in situations where they are exposed to a new partner. They might be injecting drugs. They

might have a partner whose HIV status they simply don't know about. And that can be driven by all kinds of things, notably stigma, discrimination of all forms. And so this is something that we really hope, you know, almost every Canadian will at least know about. This should be taught about from a young age, I think. And that a wide variety of people from different cross-sections society could potentially use. Is the lack of that broad knowledge and constant conversations now around HIV-N-AIDS, is that why we're still seeing new infections in this country? I mean, there have been, and you've hinted to this,

there have been a number of advances in prevention and treatment, but we're still seeing cases. That's right. And I think, you know, the explanation for that, like so many things, is extraordinarily complex. I can offer a few thoughts around, you know, why I think it's happening. You know, since the beginning of the epidemic, like so many other health issues and infectious diseases, HIV exploits inequities in our society, right? That's why we see since the beginning, you know, roughly half, almost half of infections occurring in gay bisexual, other men who have sex with men, in certain indigenous communities, in people who use drugs, you know, cutting across all these groups.

We see it disproportionately affect people who have less socioeconomic means, black, other racialized people. You know, it cuts across these inequities and it exploits them. And, well, why is that? Well, I think mechanistically, again, there's many other explanations. But one of them is simply a lack of awareness. There's perhaps not as much priority that's typically been put into getting the message out there to some of these equity-deserving groups. People often lack the simple means, of course, to access material resources, to access health care, to use a new good that sometimes does require a payment out of pocket, unfortunately, in some parts of the country. And I think another reason that's important to note is that there has literally been attacks on science, right?

In the current political climate, we've recently in this province of Ontario seen an evidence-based intervention, supervised injection sites literally lose their funding and forced to be closed. I mean, that is an evidence-based intervention that prevents HIV and saves lives. But then maybe one last important overarching theme that touches on the way you ask the question is that there's just not as enough public health measurements. messaging out there, I think, about this. I like to give the comparison to flu shots. It's flu season here in Canada right now, and I think pretty much every person who lives in Canada who's paying attention knows that their public health authorities, their doctors, their health care providers recommend that they get a flu shot. Now, what they do with that information is another story. We know that uptake isn't as high as we like it. But everybody knows, at least, that this

is a good idea, that public health believes in this. I'm not so convinced that everyone would say the same thing about HIV prep. Is that why you had that reaction when I said that these drugs are advertised in some ways? There was a bit of a smile on your face because if you see those ads, they don't actually say what the ads, what the drug does. It says prep. You're right. That is exactly why I smiled.

You know, I take the subway and here in Toronto sometimes to get to work and you'll see big bullboards, yes, about, that we'll sometimes say the word prep. But if you look at those ads very carefully, you know, take a look at, you know, who's paying for them, who is that ad from almost in very important. Variably, across this country, everywhere that I've been, those ads are coming from private clinics and pharmacies who are getting the word out because they want to be delivering it at the front lines. Not from public health. And not from public health. In contrast, we do see public health saying, hey, go get your COVID shot. Go get your flu shot. You know, measles is a big deal. All those things are true. But we're relatively silent on HIV, and I'm not clear why that is. You know, it's interesting. I'm of the age where I remember.

when AIDS was a death sentence. I remember people here in New York and elsewhere silence equals death, people fighting to get people to talk about. This is a different time now it feels like in some ways. But it's still, this is a disease that is still being transmitted, that is still costing people a great deal. When you see the promise of a drug like this, we said it's a wonder drug that has the potential to stop transmission by 100%.

What kind of hope does that give you? It gives me tremendous hope. I'm also of an age where I remember, you know, the dawn of this epidemic and there was terror. And indeed, I think silence can still equal death if we're not careful, if we don't do something about that. There's a lot of, there's too much silence still in terms of talking about and celebrating this intervention. The behaviors that put people at risk for HIV continue to be inappropriately stigmatized when, you know, having sexual activity. is part of life, right? It's part of human behavior. And yet we don't want to talk about it. So I see tremendous promise in this drug as long as we deploy it carefully. We've seen

time and time again with new innovations that if we just rely on, you know, people to talk amongst themselves and for the information to diffuse kind of naturally through a population, it will leave out people. It will disproportionately fail to get access to the people who can indeed benefit the most because they are the ones who are at the most disadvantage. And that sort of perpetuation of inequity would be a failure. So I think it's really exciting that this is on the horizon. I think we need to prepare for it meaningfully, though. And what that means is thinking very carefully about making sure it's accessible, affordable, ideally free, universally available, and to make sure that we've got the systems in place to let people know, to celebrate it,

to talk about it in a positive light, and then to actually deliver it into human bodies that could benefit. Dr. Tan, thank you very much. Thanks so much for your time. Dr. Daryl Tan is an infectious disease clinician scientist at St. Michael's Hospital in Toronto, holds the Canada Research Chair in HIV Prevention, and the lead author of Canada's new guidelines for pre-and-post exposure prophylaxis against HIV. This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always over-delivers. You've got to be 6,500 hospitals. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much with so little.

You've got to be Scarborough, defined by our uphill battle and always striving towards new heights. And you can help us keep climbing. Donate at lovescarbro.cairbo.ca.com. Are your pipes ready for a deep freeze? You can take action to help protect your home from extreme weather. Discover prevention tips that can help you Be climate ready at keep it intact.ca. Across Zambia, Eswetini and South Africa, the first real world test of this drug got underway this week. At a clinic near Pretoria, this young woman was among the first people to take a dose. I just lost my mom.

She was HIV positive. So that's why I take this serious. It's a disease, like a very, very, very painful disease. So that's why I take serious about this. Let me be safe and try this. My next guest is a senior researcher working on the Lena Capoevier implementation study. Dr. Catherine Martin is with the Witts Reproductive Health and HIV Institute in Johannesburg. Dr. Martin, hello to you.

Hello, it's lovely to be with you today. It's great to have you here. How significant from your perspective, we've been talking about the promise of this drug. How significant is this rollout? It's really important to us, especially in the eastern and southern Africa. region where the region accounts for over half of the world's burden of HIV and where it particularly affects adolescent girls and young women. So we are very excited about the opportunity to have this intervention to be able to offer to particularly to young women. The statistics are that

more than 120 young women and girls in South Africa alone are infected every single day. Is that right? Yes, we have very high rates of new HIV infections, and it does particularly affect adolescent girls and young women. And so what sort of uptake for this drug are you expecting? Because your study is offering people a choice of the Lanakapavir or the daily prep fills that are available now. So what sort of uptake are you expecting? Yes, absolutely. So I think this, what's really exciting about this study is that it will be one of the first. first times that we are able to offer a choice of either oral prep or injectable, Lena Capoevier. We've seen some early excitement about the possibility of injectable

prep. I think in our context, an injectable option offers a discrete option. A long-axing option is particularly attractive as well, particularly to young people who may have challenges in accessing health services, or we're giving a daily oral pill. may also have its challenges. And so we, it's early days, but we are expecting that there may be a lot of interest in an injectable option. But really, this is one of the things that we'll be looking at with this early rollout, is to understand how people are making that choice, what the uptake is, and really how do we integrate Lenny Kappavir within a broader package of health services. How difficult will it be to get the drug to the people who want it? I mean, you've walked

through a number of things in terms of making sure that there is interest, but getting it into the bodies of those who wanted. What are you up against? Yeah, absolutely. I think that there are a number of steps that need to be taken at a country level. I think, as you discussed with your previous guest, that approval by country regulators is important, and this can be quite a process as well. And we saw this happen with remarkable speed in South Africa, which is really encouraging. And there are already a number of regulatory approvals in place across the world,

including, as you mentioned, the FDA. What was also helpful was that the European Medicines Agency and the EU Medicines for All program also reviewed Lenna Capavia, and this is really going to help to expedite regulatory approval in low and middle income countries. The next thing really at a country level is also to make sure that it has been incorporated into national policies and guidelines. So this is often driven by political will.

But one of the major barriers that we see to introducing new products or new technologies in low and middle income countries can be the cost of new products. And so we have seen in the past that new products have not been able to reach those who need them if they remain at prices that are unaffordable. But what we are seeing with Lennar Kappavir is some remarkable and groundbreaking work in terms of making the price of Lennar Kappavir affordable and also working to make sure that there are sufficient quantities to meet demand and that the supply is sustainable.

Dr. Tan also talked about the context that this is happening in, and he was speaking specifically about attacks on science. There are also attacks and cuts to foreign aid budgets, particularly USAID and the cuts from the Trump administration. Is that going to have an impact on the rollout of this drug? I think that that has caused some disruption in services to some extent, but we are also looking forward as to how things can be made more sustainable and how, you know, countries can be able to sustain their own programs. I think one of those important considerations is the price of these new drugs. And so, as I mentioned, kind of making sure that the prices that is affordable is really important

to that sustainability. We have also known that the Global Fund has committed to support some early introduction of Len in the next year or two, which is also really helping to pave the way for the introduction. Fighting this epidemic has been your life's work. And I just wonder from a personal perspective, what it's like for you to hear the results of this research and to think about the possibility, the potential that we could be free from this disease. Yeah, it really does. kind of make one reflect. And I think, you know, thinking back to the time when I just started

working as a junior doctor and working in extremely busy hospital wards, it was an extremely challenging time for us. And antiretroviral treatment was not widely available. We were battling a daily tide of very ill patients, often young people and devastation in our communities. But we've also really see what can be done when we can come together as a global community, when we bring together the expertise of scientists, of advocates, communities, healthcare workers and ministries of health. And we have collectively seen some of these remarkable advances in access to HIV treatment. And it's really exciting to see that we are now also seeing some groundbreaking work in HIV prevention. I mean, there isn't a lot of good news in the world right now. This feels like a

really good news story. Absolutely. It really is. Dr. Martin, it's good to speak with you about this. The promise that we have been talking about feels really encouraging. We'll follow this along. In the meantime, thank you very much. Thank you so much. Dr. Catherine Martin is with the Witts Reproductive Health and HIV Institute in Johannesburg,

and she is a senior researcher working on the Lanakapavir implementation study that got underway in South Africa this week. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca.ca slash podcasts.