An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP — Essential or Irrelevant?

This Perspective explores whether an HIV vaccine remains necessary in light of the exceptional efficacy of twice-yearly lenacapavir, which showed 89–100% protection across the PURPOSE trials. While lenacapavir mimics many advantages of an ideal vaccine durable protection, ease of use, and thermostability.it falls short in duration, universality, and resilience during health system disruptions. The authors argue that PrEP requires repeated health care access and personal risk perception, making it vulnerable to inequity and stigma, particularly in under-resourced or marginalized populations. Vaccines offer broader protection through universal delivery models, and their effectiveness is less affected by adherence or stigma. Concerns about drug resistance, cost, infrastructure, and potential barriers to trialing vaccines when PrEP is widely available are also discussed. The piece concludes that both tools injectable PrEP and a long-lasting vaccine are complementary and jointly essential to achieving an end to the HIV epidemic.

This Perspective explores whether an HIV vaccine remains necessary in light of the exceptional efficacy of twice-yearly lenacapavir, which showed 89–100% protection across the PURPOSE trials. While lenacapavir mimics many advantages of an ideal vaccine durable protection, ease of use, and thermostability.it falls short in duration, universality, and resilience during health system disruptions. The authors argue that PrEP requires repeated health care access and personal risk perception, making it vulnerable to inequity and stigma, particularly in under-resourced or marginalized populations. Vaccines offer broader protection through universal delivery models, and their effectiveness is less affected by adherence or stigma. Concerns about drug resistance, cost, infrastructure, and potential barriers to trialing vaccines when PrEP is widely available are also discussed. The piece concludes that both tools injectable PrEP and a long-lasting vaccine are complementary and jointly essential to achieving an end to the HIV epidemic.