HIV Cure Prospects Within the Next Decade
A complete cure for HIV is unlikely within the next 10 years, though significant advances in functional cure strategies may emerge as research progresses in areas like "shock and kill" approaches, gene therapy, and immune-based therapies. 1
Current Status of HIV Treatment and Cure Research
Current antiretroviral therapy (ART) has transformed HIV from a fatal disease to a manageable chronic condition, with treated individuals achieving:
- Viral suppression in 86% of cases globally
- Near-normal life expectancy when diagnosed and treated early
- Prevention of transmission when virally suppressed (U=U)
However, ART has critical limitations:
- Requires lifelong medication adherence
- Does not eliminate the latent viral reservoir
- Associated with long-term issues including chronic inflammation and accelerated aging
Types of Potential HIV Cures
Two main cure approaches are being pursued 2:
- Functional cure: Patient controls infection without therapy and without immune activation/inflammation consequences
- Eradication cure: Complete purging of all replication-competent virus from the infected individual
Current Promising Approaches
"Shock and Kill" Strategy
- Uses agents like histone deacetylase inhibitors to reactivate latent virus
- Aims to expose infected cells for clearance by the immune system
- Has shown limited success in clinical trials thus far 1
Gene Therapy Approaches
- Involves knocking in protective genes (fusion peptide, silencing RNA)
- Alternatively focuses on knocking out susceptible genes (CCR5) or the provirus
- Shows promise in preclinical models 2, 1
Immune-Based Therapies
- Broadly neutralizing antibodies (bNAbs) show particular promise
- Therapeutic vaccines and immune checkpoint modulators being explored
- May offer new opportunities to clear replicating virus and infected cells 2, 1
Challenges to Achieving a Cure
- Complexity of viral latency: The HIV reservoir is difficult to target completely
- Safety requirements: Any cure must demonstrate minimal risk compared to current ART, which is highly effective 2
- Combination approach needed: Successful cure strategies will likely require multiple agents delivered simultaneously or sequentially 1
Interim Advances in HIV Management
While pursuing cure strategies, significant advances in treatment are occurring:
- Injectable cabotegravir plus rilpivirine now available as long-acting treatment option
- Every-6-months regimens combining bNAbs with lenacapavir in clinical trials
- Weekly oral combinations (islatravir/lenacapavir) showing promise 1
Realistic Timeline Assessment
The current evidence suggests that while progress is being made, a complete eradication cure remains a long-term goal beyond the 10-year horizon. The complexity of HIV latency mechanisms, safety requirements, and need for combination approaches all suggest that a widely available cure is not imminent within the next decade.
Key Considerations for Clinicians
- Maintain focus on early diagnosis and treatment with current ART regimens
- Consider long-acting treatment options for appropriate patients
- Stay informed about clinical trials of cure strategies
- Set realistic expectations with patients about cure prospects while acknowledging ongoing research progress
The search for an HIV cure remains both aspirational and necessary, but the timeline for achieving this goal extends beyond the next decade for most people living with HIV.