Uhm... Last I checked many pharmaceuticals that compete with Gilead also operate in the HIV space.
1. Gilead owns 3 of 4 top HIV drugs. GSK owns the #2, Triumeq.
2. GSK, Merk, J&J are all megacap, viable competitors with their own HIV products. Yes, its true that Merk and Gilead are in cahoots, but this was out of fear of GSKs dominance.
3. Some other US-listed names who are developing HIV drugs: ViiV (GSK subsidiary), Bristol Myers Squibb, Janssen, Mylan, Genentech, Abbvie.
Yes, the US is currently dominated by one company, but that does not mean there are heavy incentives for competitors--who are already well invested in the space--to break in.
[0]: https://www.statista.com/statistics/273434/revenue-of-the-wo...