The Future of HIV – NIFDEM Consulting

Currently, about 21 million people worldwide are receiving life-saving antiretroviral therapies, which can reduce the HIV viral load in the blood to undetectable levels. This has changed HIV from a deadly disease to a chronic and manageable disease. Moreover, the risk of transmission can now be substantially reduced with the availability and use of antiretroviral medicines.

Beyond Suppression: The Quest for a Cure

The future thrust however is to go beyond the dispensing of antiretroviral drugs that only suppress the viral multiplication to therapies that can guarantee definitive cure, thereby ending the AIDS epidemic. To achieve this goal, scientists globally are exploring various therapeutic options, including the development of vaccines, immunotherapies and genetic solutions. others are formulating long-acting treatments and still more are working on a cure.

The UNAIDS 2030 Target

In 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched an ambitious target:
“To end the AIDS epidemic by 2030.” The aim is that no child will be born with HIV and anybody already infected will be treated with medicines that give the best opportunity for healthy living.

Reflecting on the Past

This goal of ending the HIV epidemic is in contrast to the early days of the epidemic, in the 1980s and 90s, when the virus wreaked havoc across the globe, and an HIV infection was almost always fatal. This pathetic scenario has been largely changed as a result of scientific advancement in the study of the virus, the sequelae of the infection, and its treatment, which has come a long way since then.

Future Strategies for HIV Eradication

The future of a world free of HIV implies that the HIV virus has been eradicated. This feat can be achieved through the development of highly potent vaccines or the formulating of long-acting treatment that can eliminate the viral reservoirs and ensure a cure. Scientists are also exploring genetic options to HIV elimination/eradication with the testing of a technique called gene editing that involves the insertion of an HIV-protective mutation (change) into the human genome. The option of “gene editing ” or removing certain genes that enable the HIV from getting into other cells is also a feasible approach option, where although the person has the virus, it has been inactivated and can no longer infect that person or another person. Another technique is the removal of genes from HIV that have become part of the cells infected with the virus. The CRISPR technology can target the HIV genes without harming the infected cells.

With regards to vaccines, several HIV vaccine candidates have been explored but none has achieved 100% efficacy. This is however due to the fact that for most vaccine-preventable diseases, the vaccines work by mimicking the biochemistry of people who seem to be naturally protected from infection. This is however not the case with HIV, because HIV does not have a good naturally occurring protective correlate. Moreover, there is no good animal model for human HIV infections, because potential vaccines that demonstrated promise in monkeys infected with the similar simian immunodeficiency virus (SIV) have not been successful in human clinical trials. There is however room for more research in this field of HIV vaccinology.

Challenges and Innovations in Achieving a Cure

There are also hopes for an ultimate HIV cure, although this has been harder to come by than expected. The main problem with achieving a cure HIV is the problem of the latent reservoir stage of the virus in the body; during which the virus become inactive and hide in reservoirs such as lymph nodes, the gut, genital tract, and bone marrow. Currently, no existing treatment nor the immune system can detect or fight the virus when it’s inactive. That is why the leading strategy in the search for a cure is the “kick and kill” approach; which aims to “kick” the HIV out of cells acting as reservoirs and then “kill” the virus. This approach of viral eradication, or the elimination of all HIV in the body, is also known as a sterilizing cure or complete cure.

Drugs that might be able to seek out and kill HIV include histone deacetylase (HDAC) inhibitors, protein kinase activators, latency securing agents, and immunotoxins. These drugs could be used together. Such a treatment could help with compliance, as well as lessening the emotional burden of taking daily HIV treatment.

Emerging Therapies and Future Directions

Scientist are currently working on long-acting injection options that can attack the proteins coat that surrounds and protects the HIV RNA genome, that is essential to viral life including its ability to infect new cells, thereby inhibiting the ability for the virus to replicate. Other treatment options being studied include antibody therapies and therapeutic vaccines; which do not prevent infection, but stimulate the body’s own immune system to fight the virus. There is also the possibility of the drugs inhibiting the inactive virus in the reservoirs and making them remain dormant for good, even if the person stops the ART.

Innovative Techniques in Research

The transplanting of pluripotential stem cells from individuals with rare inherited gene mutation that makes them resistant to HIV infection into HIV infected subjects, was found to stop the further replication of the virus. All the cells in the transplant recipients’ immune systems were replaced by these donor cell. The recipients stopped the ART, and no longer had any signs of the virus, even years later. This technique is however expensive, risky and not practicable for widespread use.

Researchers are equally exploring the mRNA technology. This technology was adopted in developing the COVID-19 vaccine. An mRNA molecule can instruct the cells to make proteins that trigger an immune response, which can help to fight off the virus. As a way of searching for a cure, scientists are working on a way to send mRNA to immune system cells within HIV reservoirs to stimulate an immune response that can destroy the latent virus.

A Call to Action

NIFDEM and MEDELA NG join the United Nations and the global scientific community in working toward eradicating the scourge of HIV/AIDS by 2030. Achieving this ambitious goal will require a combination of: