Global Antiviral Drugs Market Outlook, 2031

The global antiviral drugs industry covers medicines that treat or prevent viral infections, including HIV, hepatitis B, hepatitis C, influenza, COVID-19, herpes viruses, cytomegalovirus, respiratory syncytial virus and emerging threats such as mpox and avian influenza. HIV antiretrovirals make up the largest share of market value, led by Gilead Sciences, whose Biktarvy is one of the world's best-selling medicines, and ViiV Healthcare, majority owned by GSK with Pfizer and Shionogi, which markets dolutegravir-based regimens and long-acting cabotegravir. Merck, Johnson & Johnson and AbbVie also have significant antiviral portfolios. COVID-19 antivirals, including Pfizer's Paxlovid, Merck's Lagevrio, Gilead's Veklury and Shionogi's Xocova in Japan, generated tens of billions of dollars in 2021 and 2022 before sales fell sharply. Hepatitis C is treated with curative direct-acting antivirals such as Gilead's Epclusa and Harvoni and AbbVie's Mavyret, while hepatitis B is managed with tenofovir and entecavir. Influenza antivirals include Roche's Tamiflu, now largely generic, and Xofluza, while herpes and cytomegalovirus are treated with acyclovir, valacyclovir, letermovir and maribavir. Generic manufacturers in India, including Cipla, Hetero, Aurobindo, Mylan and Laurus Labs, supply low-cost antiretrovirals and hepatitis drugs to low- and middle-income countries under voluntary licences through the Medicines Patent Pool. The pandemic produced the biggest shock the antiviral market has seen. Governments bought vast quantities of Paxlovid, Lagevrio and remdesivir in 2021 and 2022, making Paxlovid one of the best-selling drugs in the world for a brief period, before demand collapsed as immunity rose, testing fell and government stockpiles expired; Pfizer transitioned Paxlovid to commercial markets in the United States in late 2023. HIV has become the most important long-term growth area. Long-acting injectable regimens, including ViiV's Cabenuva for treatment and Apretude for prevention, and Gilead's twice-yearly lenacapavir, approved as Sunlenca for multidrug-resistant HIV in 2022 and as Yeztugo for pre-exposure prophylaxis in June 2025, are changing how HIV is managed. The WHO recommended lenacapavir for HIV prevention in July 2025, and Gilead agreed to supply low-income countries at no profit alongside generic licences. At the same time, cuts to US global health funding in 2025, including the dismantling of USAID and disruption of PEPFAR programmes, threatened HIV treatment and prevention in Africa and elsewhere. New threats continue to appear, including the spread of H5N1 avian influenza in US dairy cattle since 2024 and mpox outbreaks declared a global health emergency by the WHO in August 2024, while tecovirimat failed to show benefit for mpox in trials, highlighting gaps in antiviral preparedness. Market Dynamics Market Drivers • Large and Growing HIV Treatment and Prevention PopulationsAbout 40 million people live with HIV worldwide, and most require lifelong antiretroviral therapy. As more people are diagnosed and treated, and as treated patients live longer, the number of people on therapy continues to rise. Pre-exposure prophylaxis, including daily oral pills and long-acting injections, is expanding among people at risk. Long-acting regimens command premium prices in high-income markets, supporting value growth even as generics dominate volume in low-income countries. • Pandemic Preparedness and Emerging Viral ThreatsCOVID-19, mpox, H5N1 avian influenza and outbreaks of dengue, Ebola and Marburg have reinforced the need for antiviral treatments and stockpiles. Governments fund development and procurement through agencies such as BARDA, HERA in the EU and CEPI, and maintain stockpiles of influenza antivirals. Broad-spectrum antivirals that can work against families of viruses are a research priority, and companies are developing next-generation influenza and coronavirus drugs. Market Challenges • Volatile Demand and Generic CompetitionAntiviral demand can swing dramatically, as shown by the collapse of COVID-19 antiviral sales after 2022. Many established antivirals, including oseltamivir, acyclovir, valacyclovir, tenofovir and older HIV drugs, face generic competition, and patents on important HIV drugs will expire during the forecast period. Hepatitis C cures reduce the treated population over time, limiting market growth despite continued need in undiagnosed patients. • Access Gaps and Funding UncertaintyMany patients with HIV, hepatitis B and hepatitis C in low- and middle-income countries remain undiagnosed or untreated because of cost, weak health systems and limited testing. Reductions in international donor funding in 2025, particularly from the United States, disrupted HIV treatment and prevention programmes. High prices of new long-acting HIV drugs in high-income markets also limit access, and payers face pressure to balance innovation with affordability. Market Trends • Long-Acting HIV Treatment and PreventionThe HIV market is moving from daily pills to long-acting options. Cabotegravir and rilpivirine injections every one or two months, cabotegravir PrEP every two months and lenacapavir PrEP every six months offer alternatives for people who struggle with daily adherence. Companies are developing once-weekly oral regimens, such as Gilead's islatravir and lenacapavir combination and Merck's doravirine and islatravir, as well as twice-yearly treatment regimens. Long-acting products could reshape market shares over the forecast period. • Next-Generation Respiratory and Hepatitis AntiviralsCompanies are developing improved antivirals for influenza, COVID-19 and respiratory syncytial virus, including oral protease inhibitors and drugs for post-exposure prevention, such as Shionogi's ensitrelvir. For hepatitis B, functional cure approaches using small interfering RNA, antisense oligonucleotides and immune modulators, such as GSK's bepirovirsen, are in late-stage trials. Hepatitis D treatments, including bulevirtide approved in Europe, address a severe form of viral hepatitis. Segment Analysis HIV antiretrovirals account for the largest share of antiviral market value, while COVID-19 antivirals have declined sharply from their 2022 peak and hepatitis, influenza and herpes antivirals form stable but smaller segments. HIV antiretroviral drugs, including integrase inhibitors such as bictegravir, dolutegravir and cabotegravir, nucleoside reverse transcriptase inhibitors such as tenofovir alafenamide and emtricitabine, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and the capsid inhibitor lenacapavir, generate the largest share of antiviral revenue, with Gilead's Biktarvy and Descovy and ViiV's Dovato, Triumeq, Cabenuva and Apretude leading sales. Hepatitis C direct-acting antivirals, including sofosbuvir-based regimens and glecaprevir-pibrentasvir, cure most patients in 8 to 12 weeks, but revenue has declined as the pool of diagnosed patients has shrunk and prices have fallen. Hepatitis B antivirals, including tenofovir and entecavir, suppress the virus but rarely cure it, and are widely used in China and other Asian countries. Influenza antivirals, including oseltamivir, zanamivir, peramivir and baloxavir, are used for treatment and prevention and are stockpiled by governments. COVID-19 antivirals, including nirmatrelvir-ritonavir, remdesivir, molnupiravir and ensitrelvir, remain important for high-risk patients but at far lower volumes than in 2022. Herpes virus antivirals, including acyclovir and valacyclovir, are mostly generic. Cytomegalovirus antivirals, including letermovir and maribavir, protect transplant recipients. Antivirals for mpox, smallpox, RSV and other viruses form smaller segments, and monoclonal antibodies such as nirsevimab and clesrovimab prevent RSV in infants. Oral antivirals account for the largest share of prescriptions, while long-acting injectables are the fastest-growing route of administration, particularly in HIV. Oral tablets and capsules are the standard route for most antivirals, including single-tablet HIV regimens, hepatitis C cures, hepatitis B suppression, influenza and COVID-19 treatment and herpes suppression. Single-tablet regimens have improved adherence in HIV by combining several drugs in one daily pill. Long-acting injectable antivirals, including intramuscular cabotegravir and rilpivirine given every one or two months and subcutaneous lenacapavir given every six months, have become the fastest-growing route, offering discretion and reduced pill burden for treatment and prevention. Intravenous antivirals, such as remdesivir, peramivir, ganciclovir, foscarnet and cidofovir, are used in hospitals for severe infections. Inhaled antivirals, such as zanamivir, are used for influenza. Topical antivirals, including acyclovir cream for cold sores and ophthalmic ganciclovir, treat localised infections. Monoclonal antibodies against viruses, including RSV and COVID-19 preventive antibodies, are given by injection. Implantable and other extended-release systems are being developed for HIV prevention. Paediatric formulations, including dispersible tablets of dolutegravir, have improved treatment for children in low-income countries, supported by generic manufacturers and global health partners. Treatment accounts for the largest share of antiviral use, while prevention, including HIV pre-exposure prophylaxis, post-exposure prophylaxis and transplant prophylaxis, is growing rapidly. Treatment of established infections, including lifelong HIV therapy, hepatitis B suppression, curative hepatitis C therapy and short courses for influenza, COVID-19 and herpes infections, represents the largest application of antiviral drugs. HIV treatment alone involves tens of millions of people worldwide, most of them in sub-Saharan Africa using generic regimens. Prevention has become a major growth area. HIV pre-exposure prophylaxis, with daily oral tenofovir-based pills, bimonthly cabotegravir injections and twice-yearly lenacapavir, is used by several million people and is expanding with long-acting options. Post-exposure prophylaxis is used after potential HIV exposure. Influenza prophylaxis is used during outbreaks in nursing homes and households. Cytomegalovirus prophylaxis with letermovir protects stem cell and kidney transplant recipients. Prevention of mother-to-child transmission of HIV and hepatitis B uses antivirals during pregnancy. Suppressive therapy for recurrent genital herpes is common. Government stockpiles of influenza and smallpox antivirals form a separate procurement segment for pandemic preparedness. COVID-19 post-exposure prophylaxis with ensitrelvir has shown positive results and could add a prevention use for coronavirus antivirals. Retail and specialty pharmacies account for the largest share of antiviral distribution in high-income markets, while government and donor-funded programmes supply most antivirals by volume in low- and middle-income countries. Retail pharmacies dispense influenza, COVID-19 and herpes antivirals and many HIV and hepatitis prescriptions in high-income markets. Specialty pharmacies manage high-cost HIV, hepatitis B and hepatitis C medicines in the United States, coordinating insurance approvals and adherence support. Hospital pharmacies supply intravenous antivirals for severe infections, transplant patients and hospitalised COVID-19 cases. Clinics and infusion centres administer long-acting injectable HIV treatment and prevention. Online pharmacies and telehealth services have become important for PrEP, herpes suppression and COVID-19 treatment. Government programmes, including the US Ryan White programme, AIDS Drug Assistance Programs and Medicaid, fund HIV treatment for many patients. In low- and middle-income countries, national HIV programmes supported by the Global Fund, PEPFAR and UNITAID procure most antiretrovirals, largely generic products from Indian manufacturers, at prices of less than USD 100 per person per year. The Medicines Patent Pool licenses patented antivirals, including dolutegravir, nirmatrelvir and lenacapavir, to generic manufacturers for supply in eligible countries. Government stockpiles and emergency procurement form another channel. Regional Analysis North America leads the antiviral drugs market by value because of high HIV drug prices, large use of branded long-acting therapies and the presence of Gilead, Merck and ViiV's US operations, while sub-Saharan Africa has the largest HIV treatment population by volume. North America, particularly the United States, generates the largest share of antiviral revenue, driven by branded HIV treatment and prevention, specialty pharmacy distribution and high prices. Gilead's Biktarvy and Descovy and ViiV's long-acting regimens are widely used, and the approval of lenacapavir for PrEP in June 2025 expanded prevention options. The United States also accounted for most of the commercial Paxlovid market after 2023. Europe is a major market with government-funded HIV and hepatitis programmes, lower prices than the United States and strong uptake of hepatitis C cures, and the EU approved lenacapavir for HIV prevention in 2025. Asia-Pacific is large and diverse, with China having one of the largest hepatitis B populations in the world and a growing domestic antiviral industry, Japan using Xofluza and Xocova widely, and India serving as the world's main producer of generic antiretrovirals and hepatitis drugs. Sub-Saharan Africa has the largest number of people living with HIV and relies on generic antiretrovirals funded by governments, the Global Fund and PEPFAR, and funding cuts in 2025 created serious disruption. Latin America has national HIV programmes in Brazil, Mexico and Argentina, with Brazil producing some antiretrovirals locally. The Middle East has hepatitis C elimination programmes, with Egypt treating millions of people with generic direct-acting antivirals. Key Developments July 2025: The WHO issued guidelines recommending twice-yearly injectable lenacapavir as an additional HIV prevention option, supporting rollout in low- and middle-income countries. June 2025: Gilead's twice-yearly lenacapavir injection became the first six-monthly option for HIV pre-exposure prophylaxis in the United States. 2025: The dismantling of USAID and pauses in PEPFAR-funded activities disrupted HIV treatment and prevention supply chains in many low- and middle-income countries. December 2024: A US-led trial found that tecovirimat did not speed recovery from clade II mpox, following an earlier failure in clade I mpox, highlighting gaps in mpox antivirals. August 2024: The WHO declared a global health emergency over the spread of clade Ib mpox in Central Africa and neighbouring countries. November 2023: Pfizer began commercial sales of Paxlovid in the United States after government-purchased supplies ended, following a steep decline in COVID-19 antiviral demand. Considered in this report • Historic Year: 2020 • Base Year: 2025 • Estimated Year: 2026 • Forecast Year: 2031 Aspects covered in this report • Global Antiviral Drugs Market with its value and forecast along with its segments • Various drivers and challenges • Ongoing trends and developments • Top profiled companies • Strategic recommendation By Virus Type • HIV • Hepatitis B • Hepatitis C • Influenza • COVID-19 • Herpes Viruses and Cytomegalovirus • Other Viral Infections By Route of Administration • Oral • Long-Acting Injectable • Intravenous • Inhaled and Topical By Application • Treatment • Pre-Exposure Prophylaxis • Post-Exposure and Transplant Prophylaxis • Government Stockpiling By Distribution Channel • Retail Pharmacies • Specialty Pharmacies • Hospital Pharmacies • Online Pharmacies • Government and Donor Programmes

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Sikandar Kesari

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