HIV Progress Report: Are We Close to a Cure?

Health Line

3 days ago

HIV can be effectively managed with viral suppression, but there's currently no cure. The medical community is hopeful that new advancements in treatments and a vaccine may soon lead to a cure.
HIV weakens the immune system and hinders the body's ability to fight disease. Without treatment, HIV could lead to stage 3 HIV, known as AIDS.
The AIDS epidemic began in the United States in the 1980s. The World Health Organization (WHO) estimates that more than 44.1 million people worldwide have died from the condition.
There's currently no cure for HIV, but many clinical studies are dedicated to researching a cure. The current antiretroviral treatments allow people living with HIV to prevent its progression and live normal life spans.
Great strides have been made toward the prevention and treatment of HIV, thanks to:
scientists
public health officials
governmental agencies
community-based organizations
HIV activists
pharmaceutical companies
This article looks at new advancements in treatment and research milestones that may ultimately lead to a cure for HIV.
Developing an HIV vaccine
The development of a vaccine for HIV would save millions of lives. However, researchers haven't yet discovered an effective vaccine for HIV.
Research into vaccines is ongoing throughout the world. Every year, there are new discoveries.
In 2019, researchers at the University of Pittsburgh announced they had developed a promising treatment allowing them to:
engineer certain immune system cells to reactivate HIV in cells that contain inactive (latent) HIV
use another set of engineered immune system cells to attack and remove cells with reactivated HIV
Their findings could provide the foundation for an HIV vaccine.
Research on an investigational HIV vaccine conducted by the HIV Vaccine Trials Network (HVTN) that began in 2019 was stopped in 2023 due to failure to prevent HIV.
Clinical trials are ongoing.
Preventing transmission of HIV
Although there's no HIV vaccine yet, there are other ways to protect against transmission.
HIV is passed by the exchange of bodily fluids. This can happen in a variety of ways, including:
Sexual contact: During sexual contact, HIV can be passed through certain fluids, including blood, semen, or anal and vaginal secretions. Having other sexually transmitted infections (STIs) can increase the risk of HIV transmission during sex.
Shared needles and syringes: Needles and syringes used by a person with HIV may contain the virus, even if there's no visible blood on them.
Pregnancy, delivery, and nursing: People with HIV can pass the virus to their babies before and after birth. But in instances where HIV medication is used, this is extremely rare.
Taking certain precautions may protect a person from contracting HIV:
Get tested for HIV. Ask sexual partners about their status before having sex.
Get tested and treated for STIs. Ask sexual partners to do the same.
When engaging in oral, vaginal, and anal sex, use a barrier method such as condoms every time (and use it correctly).
If injecting drugs, use a new, sterilized needle that hasn't been used by anyone else.
Preexposure prophylaxis (PrEP)
Preexposure prophylaxis (PrEP) is a daily medication used by people without HIV to lower their chances of contracting HIV if exposed. It's highly effective in preventing the transmission of HIV in anyone with known risk factors.
Populations at risk include:
men who have sex with men, if they have had anal sex without using a condom or have had an STI in the last 6 months
anyone who does not use a barrier method regularly and has partners who have an increased risk of HIV or an unknown HIV status
anyone who has shared needles or used injected drugs in the last 6 months
people who are having sex without a condom or other barrier method with partners who are living with HIV
According to the Centers for Disease Control and Prevention (CDC), PrEP can reduce the risk of contracting HIV from sex by around 99% in people with known risk factors for HIV.
For PrEP to be effective, it must be taken daily and consistently. Everyone at risk for HIV should begin a PrEP regimen, according to a recent recommendation from the U.S. Preventive Services Task Force.
Postexposure prophylaxis (PEP)
Postexposure prophylaxis (PEP) is a combination of emergency antiretroviral drugs. It's used after someone may have been exposed to HIV.
Healthcare professionals may recommend PEP in the following situations:
someone thinks they may have been exposed to HIV during sex (e.g., the condom broke or no condom was used)
a person has shared needles when injecting drugs
someone has been sexually assaulted
PEP should only be used as an emergency prevention method. It must be started within 72 hours of possible exposure to HIV. Ideally, PEP is started as close to the time of exposure as possible.
PEP typically involves a month of adherence to antiretroviral therapy.
Accurate diagnosis of HIV
Diagnosing HIV is a vital step toward preventing HIV transmission. In 2021, approximately 13% of the 1.2 million people over age 13 did not know their HIV status.
There are several blood tests that healthcare professionals can use to screen for HIV. HIV self-tests allow people to test their saliva or blood in a private setting and receive a result within 20 minutes or less.
Treatment steps for HIV
Thanks to advances in science, HIV is considered a manageable chronic disease. Antiretroviral treatment allows people living with HIV to maintain their health. It also reduces their risk of passing the virus to others.
According to UNAIDS, around 77% of all people with HIV in 2024 were receiving treatment. The medications used to treat HIV do two things:
Reduce viral load: The viral load is a measure of the amount of HIV RNA in the blood. The goal of HIV antiretroviral therapy is to reduce the virus to an undetectable level.
Allow the body to restore its CD4 cell count to normal: CD4 cells are responsible for protecting the body against pathogens that can cause HIV.
There are several types of HIV drugs:
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) disable a protein that HIV uses to make copies of its genetic material in the cells.
Nucleoside reverse transcriptase inhibitors (NRTIs) give HIV faulty building blocks, so it can't make copies of its genetic material in the cells.
Protease inhibitors disable an enzyme HIV needs to make functional copies of itself.
Entry or fusion inhibitors prevent HIV from entering the CD4 cells.
Integrase inhibitors prevent integrase activity. Without this enzyme, HIV cannot insert itself into the CD4 cell's DNA.
HIV medications are often taken in specific combinations to prevent the development of drug resistance. HIV medications must be taken consistently to be effective.
An HIV-positive person should talk with their healthcare team before switching medications to reduce side effects or because of treatment failure.
Viral suppression of HIV: undetectable equals untransmittable
Achieving and maintaining an undetectable viral load (viral suppression) through antiretroviral therapy effectively eliminates the risk of passing HIV to a sexual partner.
A 2016 study found no instances of HIV transmission from a persistently virally suppressed HIV-positive partner to an HIV-negative partner.
Another 2016 study followed thousands of mixed-status couples over several years. There were thousands of instances of sex without condoms. With awareness that U=U — 'undetectable equals untransmittable' — comes a greater emphasis on 'treatment as prevention (TasP).'
UNAIDS had a '90-90-90' goal to end the AIDS epidemic. By 2020, this plan aimed for:
90% of all people living with HIV to know their status
90% of all people diagnosed with HIV to be on antiretroviral medication
90% of all people receiving antiretroviral therapy to be virally suppressed
Was this goal met?
No, this goal was not met worldwide. According to a 2020 study, South Africa was on track to achieve the first but was 20% points below the second one among people who knew their HIV status. They were close to the third, but variation by age and sex had to be taken into account.
UNAIDS has a new goal of achieving 95-95-95 by 2030. The organization reports that a few places have already hit this goal.
Milestones in HIV research
Researchers are hard at work looking for new drugs and treatments for HIV. They're hoping to find therapies that extend and improve the quality of life for people with this condition.
Additionally, they hope to develop a vaccine and discover a cure for HIV. Here's a brief look at several important avenues of research.
Monthly injections
A monthly HIV injection combines two drugs: the integrase inhibitor cabotegravir (Apretude) and the NNRTI rilpivirine (Edurant).
Research has found that the monthly injection of cabotegravir and rilpivirine (Cabenuva) was as effective at suppressing HIV as the typical daily regimen of three oral medications.
Injectable PrEP
The FDA approved a long-acting injectable form of PrEP in December 2021. Unlike the pill, which must be taken daily, the injection is given every two months.
Research has found that injectable PrEP effectively prevents the contraction of HIV. This is the first and only medication of its kind.
Targeting HIV reservoirs
Part of what makes discovering a cure for HIV difficult is that the immune system has trouble targeting reservoirs of cells with HIV. The immune system usually can't recognize cells with HIV or eliminate cells actively reproducing the virus.
Antiretroviral therapy doesn't eliminate HIV reservoirs. Researchers are exploring two different types of HIV cures, both of which would potentially destroy HIV reservoirs:
Functional cure: This type of cure would control the replication of HIV in the absence of antiretroviral therapy.
Sterilizing cure: This type of cure would completely eliminate the virus capable of replicating.
Breaking apart the HIV virus
Researchers at the University of Illinois at Urbana-Champaign have been using computer simulations to study the HIV capsid.
The capsid is the container for the virus's genetic material. It protects the virus from being destroyed by the immune system. Understanding the makeup of the capsid and how it interacts with its environment may help researchers find a way to break it open.
Breaking the capsid could release HIV's genetic material into the body, where the immune system can destroy it. It's a promising frontier in HIV treatment and cure.
'Functionally cured'
Timothy Ray Brown, an American who once lived in Berlin, received an HIV diagnosis in 1995 and a leukemia diagnosis in 2006. He's one of two people sometimes referred to as 'the Berlin patient.'
In 2007, Brown received a stem cell transplant to treat the leukemia and stopped antiretroviral therapy. HIV hasn't been detected in him since that procedure was performed.
Studies of multiple parts of his body at the University of California, San Francisco, have shown him to be free of HIV. He's considered 'effectively cured,' according to a 2013 study. He's the first person to be cured of HIV.
Research from 2019 was made public on two other men who had received diagnoses of both HIV and cancer. Like Brown, both men received stem cell transplants to treat their cancer. Both men also stopped antiretroviral therapy after receiving their transplants.
At the time the research was presented, 'the London patient' had been able to remain in HIV remission for 18 months and counting. 'The Dusseldorf patient' had been able to remain in HIV remission for 3 1/2 months and counting.
Research from 2022 mentioned a middle-aged woman who identified as mixed race had been living in HIV remission since 2017 after receiving stem cell transplants. She's referred to as the 'New York patient' and is the first woman of color to achieve HIV remission.
Takeaway
Researchers barely understood HIV more than 40 years ago, let alone how to treat or cure it. Over the decades, advances in technology and medical capabilities have brought more advanced HIV treatments.
Successful antiretroviral treatments can now halt HIV's progression and decrease a person's viral load to undetectable levels. Having an undetectable viral load not only improves the health of a person with HIV but also eliminates the risk of transmitting HIV to a sexual partner.
Targeted drug therapy can also prevent pregnant people with HIV from passing the virus to their children. Each year, hundreds of clinical trials aim to find even better treatments for HIV in the hopes of one day finding a cure.