Today, drugs can treat and control HIV infection. People who take antiretroviral therapy (ART) daily can lower the amounts of the virus in their body so much that their blood tests don’t even show it’s there. They can live long, healthy lives. They’re at almost no risk of passing the virus to others.
But if you have HIV and take ART drugs, the virus still lives inside a group of cells called the HIV reservoir. If you stop taking ART, the virus in the reservoir can spike again. Right now, there’s still no complete cure for HIV infection.
Is a Cure for HIV Infection Possible?
Scientists believe that a cure is possible. But we need to develop one that can wipe out the virus or keep you in remission without the need for daily ART.
What Is an HIV Cure?
There are two different visions of a potential HIV cure: treatment-free remission and viral eradication.
Treatment-free remission means the virus is controlled without the need for ART drugs, which a person has to take every day for life. Millions of people who have HIV can’t afford ART, so other treatments are needed. This idea of an HIV cure is also called a functional cure.
Treatment-free remission means that you’d:
- Live a healthy life that’s of normal length
- Not have to take ART or any other HIV-related drugs to keep the virus under control
- Not be able to pass on HIV to others
Many therapies are being studied as a way to control HIV without the need for daily ART. These include antibody therapies and therapeutic vaccines. They don’t prevent infection, but stimulate your own immune system to fight it.
Viral eradication is another way of looking at a potential cure. It’s also known as a sterilizing cure. Scientists believe it would take a two-part treatment to wipe out HIV in a person’s body. The first part would involve drugs that make the cells in the HIV reservoir multiply and express proteins that are a like a signal to your immune system. The second part would include drugs that detect those protein signals, then seek out and kill the virus.
Other types of drugs that may be able to seek out and kill HIV include histone deacetylase (HDAC) inhibitors, protein kinase activators, latency securing agents, and immunotoxins. These drugs may be used in combination.
Researchers are also testing a new technique called gene editing that may be able to insert the HIV-protective mutation into your genes.
Have There Been Any Breakthroughs?
One reason to hope for a cure for HIV is that experimental treatments seem to have worked in a handful of people already.
The Berlin Patient: In 2008, a man with HIV named Timothy Ray Brown was effectively cured while living in Germany. Researchers treated his blood with a stem cell transplant for leukemia, but the treatment also cured his HIV. His stem cell donor carried a mutation of an HIV-related gene called CCR5. This mutation makes a person almost completely resistant to infection. Brown was the only person to be cured of HIV until 2019, when two others were effectively cured with a similar stem cell therapy.
Visconti Cohort: In 2010, a baby born with HIV in Mississippi began ART soon after birth and was in remission for 2 years after they stopped, but the virus did come back. A trial called the Visconti Cohort studied 20 people with HIV in France. They also started ART within weeks of infection. They were able to stop taking the drugs and still have low levels of HIV years later. Another trial of 15 children with HIV in Thailand had similar results. It’s important to remember that these were controlled studies; if you have HIV, you should never stop ART without talking to your doctor.
These are positive signs, but the studies are very small. We need more research on these potential cures to be able to develop treatments that would safely work on many people, not just a small number.
Gene therapy is an area of cure research that seems promising. In the future, you might be able to just get a shot that delivers genes to your blood cells that stimulate them to wipe out HIV.
What Are the Challenges?
While research on a cure is promising, there are some challenges. One is that we don’t fully understand how HIV reservoirs work. Scientists are learning how to find, measure, and destroy them.
What about stem cell therapy? The CCR5 mutation that protects you from HIV is very rare, so it’s hard to find donor cells. Also, stem cell therapy is risky. People can reject donor cells and become very ill. Scientists are trying to find therapies that make a person’s own cells resistant to the virus, so they won’t need donor cells.
Another challenge is that males are the subjects of most HIV clinical trials, but about half of people with the virus are female. We need more studies to look at whether treatments will work on women and girls.
Even though research is very promising, it could be a few years before these treatments are tested to be sure they work well and are safe to use in many people who have HIV.