The Possibilities of Finding a Cure for HIV

A Literature Review

Abstract

The human immunodeficiency virus (HIV) is a major worldwide health concern, affecting millions of people globally, and when untreated progresses into acquired immune deficiency syndrome (AIDS). With the availability of antiretroviral therapy (ART), HIV infection is defined as a manageable, but not curable, chronic health condition. ART inhibits viral replication and prevents HIV transmission but does not eliminate the virus due to viral latency in memory T cells, exacerbated by the rise in drug resistant mutations (DRMs), so lifelong treatment and monitoring is required. In this review, we discuss the justifications and research approaches towards finding a “cure” for HIV i.e. complete elimination or control of the virus without the need for further treatment. The two main barriers to developing a cure for HIV infection are the property of HIV viral latency and high mutation rate of the virus.  A few cases of HIV have been cured through bone marrow transplants to treat acute myeloid leukaemia, where the donors had rare mutations in the CCR5 gene, required for viral entry.  More viable approaches to a cure include the “Shock and Kill” method which aims to use reverse viral latency allowing these cells to be detected and destroyed with ART,  and the “Block and Lock” method aims to block viral transcription in HIV-infected latent cells, preventing a rebound viral replication after the cessation of ART.  The possibility of vaccination has been widely explored, but an effective HIV vaccine has yet to be developed after more than 40 years of the pandemic.  Currently, the “Block and Lock” approaches appear to be the most favourable, possibly in conjunction with other recently developed interventions such as passive immunisation with broadly neutralizing antibodies.  However, approaches taken to develop a cure for HIV cannot be detached from ethical concerns which need to be acknowledged and navigated.