Gilead Sciences is coming off a milestone year that saw the start of the much-anticipated launch of the world’s first twice-yearly injectable HIV pre-exposure prophylaxis (PrEP) medicine Yeztugo (lenacapivir). Now, all eyes are on Yeztugo’s market performance as the company works to carve out a spot for the novel medicine in the established, largely oral PrEP market.
After launching in June, the long-acting PrEP is so far performing “strongly across several key launch indicators,” Gilead's chief commercial officer Johanna Mercier explained on the company's fourth-quarter and full-year earnings conference call. CEO Daniel O’Day commented that he expects Yeztugo to drive “durable, steady and long-term” growth within the company’s HIV portfolio.
After its midyear launch in 2025, the drug met the company’s sales guidance for the year. Specifically, Yeztugo generated $150 million, with $96 million coming during the fourth quarter.
Marketing push
To continue to drive growth, Gilead recently unleashed its DTC marketing campaign for the drug in the U.S., running advertisements that highlight the drug's unique twice-yearly dosing schedule. Further, the company has now secured Yeztugo coverage across all major payers and touts 90% coverage in the United States, a goal post that Gilead met ahead of its initial expectation of one year post-launch.
Now, much of the onus is on ensuring that those who received their first Yeztugo injection come back for their second dose, Mercier said. Another factor in Yeztugo’s launch trajectory is continuing the effort to “normalize HIV prevention,” the exec added, which comes with driving awareness and market expansion strategies in “very targeted communities.”
Gilead maintains that the drug is “well on its way” to reaching blockbuster status, Mercier said. The company forecasts $800 million in 2026 sales for Yeztugo, providing fuel for the 8% growth it expects for its overall HIV sector for the year. Broadening access to the drug takes “a little bit of time” as the company works through the logistics of bringing an injectable to the mostly oral PrEP market, the executive added.
The $800 million 2026 outlook has been billed as “probably” conservative by Mizuho Securities analysts. And the team at Citi Research agrees that the sales forecast looks “quite doable.”
Even without major contributions from Yeztugo as its launch picks up, Gilead’s HIV PrEP business soared to new heights in 2025. Overall, the unit delivered a 47% sales surge as older Descovy “continues to exceed expectations,” achieving record U.S. PrEP market share of more than 45%, Mercier said.
The drug, first approved as an HIV treatment in 2016 and then as a PrEP tablet in 2019, posted 31% growth of its own to $2.5 billion in yearly sales. The vast majority of the drug's sales came from the PrEP indication, the company noted in its earnings presentation (PDF).
Over time, the company anticipates “Yeztugo will be the market leader in HIV prevention, just because of the incredible profile that it offers for folks,” Mercier noted, eventually eroding Desovy’s sales, although the older treatment is expected to again grow in 2026.
“We’re excited thus far about where we stand today with Yeztugo, and all the pieces are coming together,” Mercier added.
Outside of PrEP sales, Gilead’s HIV franchise saw major contributions from leading HIV treatment Biktarvy (bictegravir), which retained its crown as the No. 1 prescribed treatment regimen for both treatment-naïve and treatment-switching patients across most major markets, according to the presentation. With $14.3 billion in 2025 sales, the drug now holds more than 52% of the U.S. HIV treatment market and continues to “set the bar for HIV treatment,” Mercier commented.
Gilead’s 2025 HIV sales totaled $20.8 billion last year, a 6% jump from 2024’s $19.6 billion.
With Yeztugo out the door, the company is cooking up new ways to market the drug's active ingredient, lenacapavir, which first rolled out as multi-drug-resistant HIV treatment, Sunlenca, in 2022. In the pipeline is the bictegravir-lenacapivir combo, which could “further extend our lead in the switch market” upon its targeted launch over the second half of 2026, Mercier said.
The company’s product sales over the year totaled $28.9 billion, good for in 1% growth. Sales this year are expected to land in the $29.6 billion to $30 billion range.
Oncology, liver disease and M&A to come
The financial performance sets the stage for what O’Day touts as a “very promising 2026,” backed by “the strongest pipeline in our almost 40-year-old history,” he said, attributing the company’s commercial and clinical milestones to come to the “success of the diversification strategy that has been shaping Gilead over the last six years.”
The exec still has an appetite for further diversification and wants to “continue to add to our pipeline with appropriate M&A” over the coming years, he said.
“We’re very ready. We’re very proactive and disciplined,” O’Day said, while acknowledging that Gilead “may not have the urgency of other companies in the sector.”
The CEO’s note on diversification calls back to the company’s major deal in the oncology space in 2020, when it bought Immunomedics and its antibody-drug conjugate (ADC) Trodelvy for $21 billion. Today, Trodelvy and its strong demand in second-line metastatic triple-negative breast cancer have kept the company’s oncology sector afloat, even through Trodelvy’s late-2024 exit from the bladder cancer market after a confirmatory trial fail marked a notable setback.
Cell therapies Yescarta and Tecartus, however, continued their sales slide in 2025, sinking 7% overall to $1.8 billion. Declines are expected to continue due to “competitive headwinds” as well as a growing number of clinical trials that, while “exciting for our industry,” are impacting commercial cell therapy volumes, Mercier noted.
Once a major focal point as the company looked to further strengthen its portfolio diversification push by expanding beyond its roots in HIV and antivirals, Gilead’s oncology sector currently matches its liver disease portfolio in annual sales, both totaling $3.2 billion in 2025.
Out of the two product sectors, only one is having a growth spurt. Gilead’s liver disease business is up 6% from the prior year due to the “rapid adoption” of its newly launched primary biliary cholangitis (PBC) treatment Livdelzi, O’Day said. Approved in mid-2024, the drug benefited from higher patient demand near the end of the year due to the market withdraw of Intercept Pharmaceuticals’ competing Ocaliva.