What is the treatment for reversing Acquired Immune Deficiency Syndrome (AIDS)?

From the Guidelines

There is no way to reverse AIDS (Acquired Immunodeficiency Syndrome), but it can be effectively managed with antiretroviral therapy (ART) as recommended by the 2024 guidelines of the International Antiviral Society-USA panel 1. AIDS is the advanced stage of HIV infection where the immune system has been severely damaged. While we cannot reverse AIDS completely, we can manage HIV infection with ART, which involves a combination of medications like Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide), Triumeq (dolutegravir/abacavir/lamivudine), or Dovato (dolutegravir/lamivudine), taken daily for life. These medications prevent HIV from replicating and allow the immune system to recover, potentially raising CD4 counts from AIDS-defining levels (below 200 cells/mm³) to healthier ranges. With proper adherence to medication, many people can achieve an undetectable viral load, meaning the virus cannot be transmitted sexually and further immune damage is prevented. However, this is not a cure or reversal - if medications are stopped, the virus will rebound. Early diagnosis and treatment are crucial, as they can prevent progression to AIDS in the first place. Regular medical monitoring, including CD4 count and viral load testing, is essential for managing the condition effectively, as stated in the recent guidelines 1. Some key points to consider in the management of HIV infection include:

• The use of antiretroviral therapy (ART) as the cornerstone of treatment and prevention 1
• The recommendation for all HIV-infected individuals with detectable viremia to receive treatment, regardless of CD4 cell count 1
• The importance of early initiation of ART in adults to reduce AIDS-related events, non-AIDS-related events, and all-cause mortality 1
• The availability of long-acting injectable therapy for those who prefer not to take daily oral medications or struggle with adherence to daily therapy 1

From the Research

Reverse AIDS Research

• The concept of reversing AIDS is closely related to the idea of finding a cure for HIV infection, which is the virus that causes AIDS.
• Research has been focused on developing antiretroviral therapies that can suppress the virus and prevent the progression of the disease 2, 3, 4.
• One of the challenges in reversing AIDS is the presence of latently infected cells, which can harbor the virus and reactivate it at any time 5, 6.
• Strategies such as the "shock and kill" approach aim to reactivate these latently infected cells and then eliminate them using antiretroviral therapy or other means 5, 6.
• Latency reversing agents (LRAs) have been identified and tested in clinical trials, but so far, they have failed to eradicate the viral reservoir 5, 6.
• Recent studies have explored the use of immune modulators in combination with LRAs to reduce the reservoir size and improve immunological control 6.

Antiretroviral Therapies

• Highly active antiretroviral therapy (HAART) involves combination treatment with three or more antiretroviral agents 2.
• The combination of emtricitabine, tenofovir, and an integrase inhibitor such as elvitegravir or raltegravir has shown high levels of synergy in vitro 2.
• Raltegravir-containing regimens have been shown to be safe and effective in treating HIV-2 infection 3.
• New antiretroviral agents and long-acting therapies are being developed to improve treatment options for HIV infection 4.

Challenges and Future Directions

• Despite the progress made in antiretroviral therapies, there are still challenges to be addressed, such as drug toxicity and acquired and transmitted drug resistance 4.
• The development of latency reversing agents and immune modulators holds promise for reducing the viral reservoir and potentially achieving a cure for HIV infection 5, 6.
• Further research is needed to understand the mechanisms of latency and to develop effective strategies for reversing AIDS 5, 6.