When Gilead Sciences released its first sales forecast for its twice-yearly pre-exposure prophylaxis (PrEP) treatment Eztugo (lenakapivir) earlier this year, analysts called the company’s $800 million outlook “likely” conservative and “very doable.”
Now that Eztugo’s launch trends have become more clear over the past few months, the company has edited its forecasts to favor the billion-dollar opportunity the drug has in 2026.
Through the first quarter, the long-acting injectable drug generated sales of $166 million. This is an “unprecedented launch trajectory” and has so far “exceeded our expectations,” explained Chief Commercial Officer Johanna Mercier on the company’s first quarter earnings call.
Gilead currently expects to generate $1 billion in revenue from the drug in its first full year on the market, but expects “steady and sustained sales growth” over the next several years as the company aims to expand adoption across populations in need of HIV prevention options.
In the long-acting injectable market, Eztugo’s main competitor is GSK’s Apritude, a bimonthly injection that was released several years before Eztugo’s introduction. Already, Eztugo and its long-term protection period are taking market share away from products offered by GSK. In addition to users switching from Apretune, PrEP users are also switching from Gilead’s Truvada and its older PrEP Descovy generic, Mercier explained on the conference call.
Eztugo’s largest market is currently from people switching from other PrEP options, but Gilead said in a company presentation (PDF) that the drug is “gaining traction” among people new to PrEP. As Mercier explains, there remains a “high unmet need” for PrEP in some parts of the country, such as the rural South, where Gilead has seen “more naive prescriptions” emerging so far.
One way to reach these potential PrEP users is through a direct-to-consumer campaign for Eztugo that launched in late February. Mercier said the marketing is trending upward in brand recognition and awareness, and also helps remind people to take their second dose of the twice-yearly shot.
It’s been about 11 months since Gilead first launched PrEP, and it’s time for many people who have already received their first dose of Eztugo to get their second dose of the year. So far, Mercier said Gilead has reason to expect Eztugo’s persistence level to “continue to grow” over time and end up being the best in the overall HIV market. So far, the company is seeing a “very good recovery” with second doses within a certain period of time, which the company considers “very positive and encouraging.”
“What we’re seeing early on is definitely much stronger than what our current competitors are seeing in the market,” Mercier said, referring to the level of sustainability.
Mercier said the “very strong” 14% growth in the U.S. PrEP market is also contributing to Descovy. Notably, Gilead’s PrEP business in the US grew 87% year over year, while Descovy’s sales increased 38% year over year to $807 million.
The company’s HIV portfolio, which includes PrEP and HIV treatment products, attracted a total of $5 billion in the first quarter, an increase of 10% from the first quarter of 2025. HIV treatment giant Biktarvy saw its own 7% growth to $3.4 billion.
Future delivery of HIV treatment services
Biktarvy currently accounts for 52% of the U.S. HIV drug market, but the first of many lenacapivir combinations that Gilead hopes to commercialize soon aims to corner a specific subset of the market for treatments for virally suppressed people with HIV after the FDA’s target date in August.
The combo prospect is a single-tablet combination of the capsid inhibitor lenacapivir and bictegravir, one of the three ingredients in Biktarvy. With bic/len, the company aims to offer a simpler option for the 5% to 6% of people living with HIV who take multiple pills a day with complex treatment regimens to manage the virus.
Importantly, Gilead sees the bic/len combination as a way to tap into the treatment switching market, which is made up of the 20% of people with HIV who switch treatments every year. This switching pattern is primarily based on the “innovative life cycle” of HIV treatment, Mercier explained.
The company expects Biktarvy to remain the standard of care until the patent cliff in the mid-2030s, but because people with HIV can theoretically switch from Biktarvy to the new combo “if they’re going to switch anyway,” bic/len presents an opportunity to “play in a switching market that hasn’t existed in the past,” the executive said.
Gilead expects its HIV business to grow 8% in 2026, with total product sales expected to be between $30 billion and $30.4 billion. Total revenue for the first quarter was $7 billion, an increase of 4% compared to the first quarter of last year.
Liver disease is on the rise and cell therapy is in trouble
Apart from Eztugo and its HIV spread, another growth highlight in Gilead’s product portfolio is its primary biliary cholangitis (PBC) treatment Livdelzi. After its launch in 2024, quarterly sales rose 230% year over year to $133 million compared to the first quarter of 2026, but fell 11% due to “switch boluses” after the fourth quarter of 2025, when Intercept’s Ocaliva, the drug’s former main rival, was withdrawn from the market.
Meanwhile, the 12% year-over-year decline in Gilead’s cell therapy portfolio of Yescarta and Tecartus was also attributed to “continued competitive headwinds” across the region. While the breast cancer drug Trodelvy and its quarterly sales of $402 million have long been the bulk of Gilead’s oncology revenue, other potentially standout oncology products are emerging.
Gilead’s acquisition of Germany-based Tubulis in April of this year resulted in a $3.15 billion investment in promising antibody-drug conjugate (ADC) candidates in the development of ovarian and lung cancers, in addition to late-stage multiple myeloma CAR-T prospect Anitocel, which the company has full control over after acquiring partner Arcelx for $7.8 billion earlier this year. Chief Financial Officer Andrew Dickinson commented that the ovarian cancer opportunity alone could justify the transaction price.
