Gilead Sciences announced that the US Food and Drug Administration (FDA) approved Bixlenvo (bictegravir 75 mg/lenacapavir 50 mg), the smallest once-daily Single Tablet Regimen (STR) for the treatment of HIV in adults who are virologically suppressed. Bixlenvo is now the first and only STR option for virologically suppressed people with HIV who are on complex regimens and unable to take currently available STRs.

This novel HIV treatment pairs bictegravir, a global guideline-recommended Integrase Strand Transfer Inhibitor (INSTI) with a high barrier to resistance, with lenacapavir, a first-in-class capsid inhibitor that has a novel mechanism of action with no cross-resistance to other antiretrovirals.

Chloe Orkin, Managing Director (MD), lead primary investigator for ARTISTRY-1 and Clinical Professor of Infection and Inequities at Queen Mary University of London, said, “Bixlenvo offers a new once-daily STR designed for the evolving needs of people with HIV. The approval is a significant advancement in HIV treatment, especially for individuals unable to benefit from guideline-recommended STRs due to challenges like pre-existing resistance or tolerability. It expands tailored, simplified dosing to people whose needs were not fully met by existing single tablet therapies."

The FDA approval is based on results from the phase 3 ARTISTRY-1 (NCT05502341) and ARTISTRY-2 (NCT06333808) trials, with data presented during late-breaker sessions at the 33rd Conference on Retroviruses and Opportunistic Infections (CROI 2026).

The trials evaluated Bixlenvo in adults with HIV who are virologically suppressed, including those who switched from complex multi-tablet regimens or from Biktarvy (bictegravir 50 mg/emtricitabine 200 mg/tenofovir alafenamide 25 mg).

In both trials, Bixlenvo demonstrated comparable efficacy in maintaining virologic suppression at week 48 and was generally well tolerated, with no significant or new safety concerns identified. Most common adverse reactions reported in at least 2 percent of participants across the ARTISTRY program were headache, nausea, and diarrhea. Detailed ARTISTRY-1 results were published in The Lancet, and ARTISTRY-2 results were published in Lancet HIV.

Daniel O’Day, Chairman and Chief Executive Officer (CEO), Gilead Sciences, said, “Bixlenvo continues Gilead's long-term commitment to innovation in HIV. Bringing together bictegravir with our first-in-class capsid inhibitor, lenacapavir, Bixlenvo offers a novel choice to people with HIV looking to switch or simplify their treatment regimen. Our goal at Gilead is to provide multiple options for HIV treatment and prevention and with a pipeline of potential daily, weekly and longer acting options, today’s approval could be the first of many in the years ahead.”

ARTISTRY-1 enrolled the oldest study population in a phase 3 registrational trial for HIV-1 treatment to date, with a median participant age of 60 years. Participants were taking between 2 and 11 pills per day at baseline, with approximately 40 percent taking antiretroviral therapy more than once daily.

Additionally, the trial participants had extensive HIV treatment experience, with a median treatment duration of 28 years, a high level of historical antiretroviral resistance (67 percent with NRTI resistance) and a high proportion of participants on a complex regimen because of antiretroviral resistance (81 percent).

The phase 3 results demonstrated that switching from complex multi-tablet regimens to Bixlenvo was associated with improvements in certain fasting lipid parameters and participant-reported treatment satisfaction. ARTISTRY-2 showed that switching to Bixlenvo had no significant impact on weight.

Bixlenvo requires a 2-day initiation dose with Sunlenca (lenacapavir), thereafter only Bixlenvo is taken orally once a day.

Bictegravir and lenacapavir in combination are not approved by any regulatory authority outside of the US.

There is currently no cure for HIV or AIDS.