Gilead Sciences (NASDAQ: GILD) reported first-quarter 2026 financial results that exceeded Wall Street expectations in both revenue and earnings per share, though the company issued revised full-year guidance reflecting significant upcoming costs. Revenue for Q1 reached $6.96 billion, a 4.4% year-over-year increase compared to analyst estimates of $6.86 billion, driven by strong performance in the HIV portfolio and oncology segments. Non-GAAP adjusted earnings per share came in at $2.03, beating the consensus estimate of $1.91, while non-GAAP operating income hit $3.27 billion with a 46.9% margin, significantly higher than the estimated 44.2%. However, management lowered its full-year adjusted EPS guidance to a midpoint loss of $0.85 due to large upfront charges related to recent acquisitions, contrasting with a previous positive outlook and representing a substantial 110% decrease in projected earnings per share from the prior year's expectation. The core HIV franchise continued to drive growth, with total HIV revenue up 10% year-over-year led by the blockbuster drug Biktarvy. The PrEP segment saw particularly explosive growth, surging 87% in the United States primarily due to the successful launch and rapid uptake of Yes2Go, a twice-yearly injectable for HIV prevention that aims to improve patient adherence compared to daily oral tablets. Management highlighted that this new modality has already achieved high prescriber adoption rates across the U.S. and Europe, positioning Gilead to maintain its leadership in the HIV market despite anticipated policy-driven pricing headwinds. Additionally, the liver disease segment received attention for Libdelzi, which more than tripled in sales in the second quarter due to strong uptake for second-line treatment of primary biliary cholangitis, although sequential declines were noted due to post-launch inventory normalization. Oncology momentum provided another pillar of growth with Trodelvy sales increasing 37% year-over-year, benefiting from updated clinical guidelines that support broader first-line use in metastatic triple-negative breast cancer. The company also diversified its oncology and inflammation pipeline through recent acquisitions, including the completed deal for Arcellx and pending agreements for Oral Medicines and Tubulis, which introduce novel assets targeting multiple myeloma and ovarian cancer with revenue expected to ramp up in 2027 and beyond. Operating margins expanded to 37.2% from the prior year's 33.5%, attributed to disciplined expense management and the expiration of certain royalty obligations that offset higher selling and integration costs. Looking ahead, Gilead remains focused on executing its expanding pipeline while managing the financial impact of integrating new assets and upcoming product launches such as Biclen, a once-daily oral regimen for virally suppressed patients. While the company expects continued growth in HIV treatment and prevention, as well as incremental revenue from these new therapies, management warned that increased R&D investment and transaction costs will weigh on short-term profits. The full-year non-GAAP operating margin is projected to remain high at 46.9%, but GAAP margins will be lower due to the significant one-time acquisition-related charges included in the calculation.