When daily oral PrEP launched, it was a revolution. An injection every two months with CAB-LA made adherence even easier. Lenacapavir goes further still: two injections a year, six months apart, giving continuous HIV protection with a lower dosing burden than any prevention method that has ever existed.

The PURPOSE 1 and PURPOSE 2 trials, published in 2024, produced results that genuinely shocked the HIV prevention community. PURPOSE 1, which enrolled young women in sub-Saharan Africa, found zero new HIV infections among the 2,134 participants on lenacapavir PrEP. Not fewer infections. Zero. PURPOSE 2 followed a broader population including men who have sex with men, transgender women, and non-binary people, and found similarly near-complete protection. These are among the strongest efficacy results ever reported in HIV prevention research.

Lenacapavir injection is now available through Zivoko. This guide explains how it works, what the dosing schedule involves, what side effects to expect, and who it suits best. When you’re ready to start, message our team on WhatsApp.

The three PrEP options and how they compare.

Lenacapavir represents the logical endpoint of the long-acting PrEP trajectory: the fewest interventions possible for maximum continuous protection. For anyone who finds even a two-monthly clinic visit burdensome, or whose life makes scheduled appointments difficult, twice-yearly dosing removes almost all of that friction. For a full side-by-side comparison, see which PrEP is right for you.

The mechanism and why it is different from other PrEP options.

Lenacapavir belongs to a new class of antiretroviral drug called capsid inhibitors, the first of its kind approved for any HIV indication. Where oral PrEP (TDF/FTC) blocks specific steps in HIV’s replication cycle, lenacapavir targets the HIV capsid, the protein shell that surrounds and protects the virus’s genetic material, disrupting it at several points in the lifecycle at once.

The long-acting formulation is given as an injection just beneath the skin of the belly, rather than deep into muscle as with CAB-LA. The drug forms a depot under the skin that slowly releases into the bloodstream over approximately six months, maintaining protective concentrations throughout. It does not carry the kidney or bone considerations associated with tenofovir-based oral PrEP, so no kidney monitoring is needed, making it an option for people with kidney concerns who cannot take standard oral PrEP.

What the twice-yearly schedule looks like in practice.

What to expect from lenacapavir injections.

The most common side effect is an injection site nodule, a small, firm lump under the skin at the injection site that forms as the drug depot establishes itself. This is expected, generally painless after the first week, and typically fades over several weeks to months. It is not a sign of infection or an allergic reaction.

Injection site redness, swelling, or tenderness is also common in the first one to two weeks after the injection, particularly after the starting doses. These are usually mild and settle on their own.

Side effects such as headache or nausea have been reported in a small proportion of people in clinical trials but are generally uncommon.

If you notice significant swelling, spreading redness, warmth, or discharge from the injection site beyond the first week, contact our team or a nurse promptly.

The people who benefit most from twice-yearly dosing.

• People who have struggled to maintain daily oral PrEP adherence despite genuine effort: irregular routines, frequent travel, shift work, or lifestyle factors that consistently interrupt the daily habit.
• People for whom complete privacy is essential and who cannot keep a daily pill discreet. Two visits per year is far easier to manage privately.
• People with kidney concerns who are advised against standard oral PrEP (TDF/FTC). Lenacapavir needs no kidney monitoring.
• People who want the lowest-burden prevention option for long-term use, where daily pill fatigue becomes a genuine adherence risk over years.
• Young women in sub-Saharan Africa, the population with the highest HIV incidence globally, and the group in whom PURPOSE 1 produced its historic zero-infection result.

Questions about lenacapavir in Nigeria.