In the past few years, finding a cure for HIV has emerged as a top priority. The reason is because antiretroviral therapy (ART) has pretty much reached its maximum level of effectiveness. When it comes to improving the power of antiretroviral medications, not much else can be done. So, now the attention turns to a cure-any type of cure. Actually, there are two types of cures that researchers are exploring, and either or both would be beneficial. The first is a sterilizing cure, which will eliminate HIV from the body completely; the second would reduce the HIV present in the body to an asymptomatic level so ART won’t be needed anymore-a functional cure.
Several different strategies have been explored in the quest to find an HIV cure. Gene therapy, immune strengthening, permanent suppression of latent virus, and certain types of drugs that work to flush HIV out of the reservoirs in the body where they hide – they’ve all been studied. HIV reservoirs are considered the final hiding place for HIV in the body, and the work will not rest until an effective strategy is developed to deal with them. They have been able to persist in HIV-positive patients-even those on ART-because they hide in places where ART can’t catch them.
Current antiretroviral medications are very effective at stopping HIV out in the open, and reduce their ability to transmit from one T-cell to another through the bloodstream; however, direct cell-to-cell transmission proves to be tricky, and ART isn’t quite as effective at stopping that. A different treatment strategy is needed. Residual HIV can be found up to 10 years after suppressive therapy has commenced, effectively making ART a lifelong practice and expense, since ART is not cheap. Adherence to such a treatment regimen can prove difficult and costly for many people around the world, especially in developing countries who lack quality access to these medications.
The two main goals in the treatment of HIV is finding a cure and developing a vaccine. Latent HIV hides in reservoirs and comes alive almost immediately after ART is stopped-no matter when it’s actually stopped. These reservoirs are established very soon after first infection, which has prompted research into starting ART on HIV-positive people as soon as they’re infected, before the reservoirs have a chance to form. Once the mystery of HIV reservoirs is solved, the final chapter of finding an HIV cure can be written, and hopefully as a corollary it will result in finding a vaccine to prevent further infections in the future.