Lenacapavir for HIV Treatment vs Prevention: Avoiding Pharmacy Dispensing Errors

This episode, "Lenacapavir for HIV Treatment vs Prevention: Avoiding Pharmacy Dispensing Errors," features the panel examining a real-world dispensing risk created by a single agent approved for two indications.

Dr. Nguyen explains that confusion is inevitable because the same molecule, lenacapavir, is marketed for two distinct uses. One product is approved for pre-exposure prophylaxis, and the other is approved for HIV treatment. Prevention use requires a negative HIV test before initiation and before each subsequent injection. Treatment use is not monotherapy, however. It must be combined with other antiretrovirals and is reserved for heavily treatment-experienced patients with multidrug resistance or failing regimens.

When the prescription reaches the pharmacy, Dr. Nguyen says the first step is to double-check the diagnosis. Some electronic health records let prescribers indicate HIV-negative status, but systems differ in capability. Some display only the generic name, so the correct product must be selected. She describes the pharmacist as the second checkpoint after the prescriber. The key anchor is confirming that the diagnosis and HIV status match the product dispensed. She adds that the prevention product is heavily advertised, while the treatment product has limited distribution. A retail pharmacist unfamiliar with HIV care may therefore assume every lenacapavir prescription is for prevention. That assumption should never be made.

Dr. Madison stresses that discussing treatment with someone seeking prevention could be upsetting and off-putting. Dr. Astle adds that long-acting agents revive the older all-or-none counseling principle. Clinicians have grown comfortable with complete single-tablet regimens, but treatment lenacapavir and treatment cabotegravir both require companion agents. Pharmacists must ensure patients are not left on functional monotherapy, particularly when delivery delays occur. Dr. Madison agrees that coordination and accurate records are essential. Dr. Burkhart encourages patients to fill all medications at one pharmacy so the complete regimen is visible. Dr. Madison notes that patients average about 20 pharmacy touch points a year, which makes that consistency valuable.

In "Why HIV Innovation Continues: New Mechanisms and the Long-Acting Pipeline," the panel will explore why the field keeps investing in new mechanisms and which long-acting candidates pharmacists should be watching.

Funding supported by Gilead. Content independently developed by Pharmacy Times