Overall, we expect general medicines to decrease mid-single digit percentage in 2024 and this guidance takes into account the AMCAP removal in the US, which we previously highlighted as impacting the business by up to US$700 million. We provided for around 20% of this in 2023 and continue to expect a broadly flat outlook between 2021 and 2026. I’ll now hand over to Deborah to cover HIV.
Deborah Waterhouse: Thank you, Luke. HIV sales grew 13% to £6.4 billion in 2023 driven by a notable acceleration in our oral two drug and long-acting injectable regimens. Sales from these two areas represent 55% of our portfolio compared to an exit of 46% in 2022. For the year Dovato sales grew 33% to £1.8 billion. Cabenuva grew more than 100% with sales over £700 million and Apretude contributed sales of £149 million. The growth of these products reflects strong patient demand and our deep commitment to innovation. For long-acting regimens, specifically, more than 80% of US healthcare prescribers now tell us they are convinced that these regimens will become a key part of HIV care. Based on this demand and our growth and momentum, we’re projecting a growth rate of high-single to low-double-digits in 2024.
We’re excited by the potential of our early-stage pipeline to deliver more innovative longer-acting injectable regimens. And as I said at last year’s investor event, 2024 will be an important year for us as we select regimens for four-monthly treatment and self-administered treatment as well as starting the registrational studies for our four-monthly prep. We will be presenting data on our early pipeline and our current portfolio at CROI in March. To conclude, 2023 was another positive year of performance and portfolio development. As such, we’re looking forward to 2024 and are confident that we are well on track to deliver our 2021 to 2026 sales ambition of 6% to 8%. With that, I shall hand to Julie.
Julie Brown: Thank you, Deborah, and good morning, everyone. Next slide please. Starting with the income statement with growth rates stated at CER. Sales increased 14%, excluding COVID solutions and were up 5% overall, reflecting continued strong business performance. Adjusted operating profit grew 16%, excluding COVID and 12% overall. The margin increased to 29% and driven largely by favorable product mix and operational efficiencies as well as increased royalties. COGS and SG&A grew broadly in line with sales excluding COVID. R&D costs increased due to the investment in late-stage programs in vaccines respiratory, immunology and infectious diseases with the step-up in Q4 due to reorganization costs and the acceleration of late-stage projects.
Adjusted earnings per share grew 22% excluding COVID solutions and 16% overall. And this benefited also from lower net finance expense, down 15% following debt restructuring. The effective tax rate was 15.5% in line with our guidance. Turning to the reported results. Total operating profit increased 10% to £6.7 billion driven by overall performance and favorable CCL movements. The reconciliation of total to adjusted results is included in the appendix. On currency there was an adverse 200 basis point impact on sales and 400 basis points on adjusted operating profit versus the prior year, primarily due to the strengthening of sterling against emerging market currencies. Next slide please. Moving on to the adjusted operating margin dynamics for the year.
On this slide we have shared including and excluding COVID to provide an underlying review of margin dynamics. Excluding COVID solutions, the margin improved 60 basis points at CER to 29.1%, due to improved product mix, productivity improvements and increased royalty income. Including COVID, there was a 180 basis point improvement, primarily reflecting reduced sales of lower margins Xevudy. Regarding SG&A growth was focused on investment in vaccines including disease awareness and the launch of Arexvy together with Shingrix long-acting HIV, Jemperli and Ojjaara. Royalty income also contributed to margin improvement. Next slide please. Free cash flow increased to £3.4 billion. And this despite annualizing the receipt of £0.9 billion from Gilead in 2022.
This increase was primarily driven by higher operating profit together with favorable timing of Xevudy cash flows and a lower UK pension contribution. This was partly offset by higher trade receivables from sales of Arexvy in the last quarter. Q4 CGFO performance was particularly strong delivering £3.7 billion versus £2.1 billion last year. And this increase was primarily driven by higher collections following the strong launch of Arexvy in Q3. We expect cash generated from operations to remain strong and we’re fully committed to delivering more than £10 billion by 2026. Next slide please. Slide 19 shares our net debt position and how we’ve deployed capital in the business in line with the capital allocation framework. We look to deploy funds to enhance growth and deliver attractive shareholder returns.
We started the year with net debt of £17 billion and strong free cash generation in addition to the monetization of our stake in Haleon supported £3.8 billion of investment in targeted business development and capital expenditure and £2.2 billion in returns to shareholders via the dividend. Overall this led to a further reduction in net debt to £15 billion by the end of 2023 and a net debt to adjusted EBITDA ratio of 1.5 times. Post the year-end we conducted a further sale of 300 million Haleon shares yielding proceeds of 978 million and leaving our equity holding at just over 4%. Further, we reached a successful agreement to acquire Haleon Bio subject to customary regulatory clearances and to further strengthen our respiratory portfolio.
I’ll now turn to our expectations for the coming year. Next slide please. In 2024, we expect another year of meaningful growth for GSK. We expect sales to increase between 5% and 7%, adjusted operating profit to increase between 7% and 10% and adjusted earnings per share to increase between 6% and 9%. Important to note that the cessation of Gardasil royalties negatively impacts profit growth by six percentage points within our 2024 guidance. As a reminder, our guidance is provided at CER and excludes the impact of COVID-19 solutions. Some points to note for modeling purposes. Firstly our sales composition. As Luke and Deborah have said for vaccines we expect high single-digit to low double-digit percent growth. For Specialty Medicines, we expect a low double-digit percent growth.
