A cure for HIV: is it in sight?

Abstract

HIV is a devastating disease affecting millions of people worldwide despite the advent of successful antiretroviral therapy (ART). However, ART does not result in a cure and has to be taken for life. Accordingly, researchers are turning towards cure efforts, particularly in the light of two patients whose HIV has been seemingly eradicated. Numerous approaches and strategies have been considered for curing HIV, but no scalable and safe solution has yet been reached. With newly discovered difficulties in measuring the HIV reservoir, the main barrier to a cure, the only true test of cure is to stop ART and see whether the virus becomes detectable. However, it is possible that this treatment interruption may be associated with certain risks for patients. Here, we compare the current major approaches and recent advances for curing HIV, as well as discuss ways of evaluating HIV cure and the safety concerns involved.

Keywords::

• HIV
• cure
• functional
• kick and kill
• sterilising

Financial & competing interests disclosure

The authors were funded by the National Institute of Health Research Oxford Biomedical Research Centre. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Several different approaches exist for exploring potential cures for HIV, including genetic, ‘kick and kill,’ immune-based and early treatment strategies.

• The only successes in achieving cure to date are impossible to scale up and/or cannot be applied to the millions of chronically infected individuals.

• New research has shown the reservoir is larger than previously estimated and therefore harder to eradicate.

• Difficulties in measuring the latent reservoir mean that currently taking patients off therapy is the only way to verify a cure.

• Taking patients off antiretroviral therapy may come with safety risks that must be addressed.

• There are limited studies evaluating potential markers that could predict patients who would do well off therapy (control viremia or avoid morbidity).

• Future strategies for HIV cure should include combination strategies.