Designing New Approaches to Cure HIV Infection
Several new approaches are ready to be tested to try to reach an HIV cure, at least a functional one where life-long ART is no longer necessary.
The elimination of HIV reservoirs is what is often seen as the final step in finding a cure for HIV. During antiretroviral therapy (ART), the drugs are very effective in eliminating HIV from the bloodstream; however, small quantities of virus hide out in cells in the gut and lymphatic tissue. ART drugs cannot detect the virus in these cells because the viral load will have fallen below detectable quantities by then. These cells are referred to as HIV reservoirs, because they serve as pools for which the virus can replicate once ART stops. This is why a cure is needed, because as it stands now, using antiretroviral therapy simply perpetuates a never-ending cycle of infection.
New approaches to finding a HIV cure must be explored if a cure will ever be feasible. Eliminating HIV reservoirs will be a challenge—a very difficult challenge—but this is where all research must begin. For example, directly targeting HIV after it has infected cells and permanently making the virus within these infected cells in active is something to consider. Secondly, creating new methods for dealing with HIV persistence is very important. HIV reservoirs are part of this persistence, and figuring out why these reservoirs are created and where they're typically found is vital. Maybe selectively killing cells that contain HIV genes is a feasible approach; this is where the research comes in.
These new approaches include 2 ways of modifying cells. First, the cells can be modified such that they'll become less receptive to HIV in the first place. This would invariably involve genetic manipulation, and much work has already been done in this area. A second method would be to keep the infected cells from going inactive, giving HIV a hiding place during ART. By inhibiting the cell's ability to shut itself down, it remains active and available for ART to reach, which thereby increases the probability that, in conjunction with strong ART, the body's immune system could keep any remaining virus at undetectable levels, creating a functional cure for HIV.
This is great to talk about, but the funding has to be there to make it happen. Designing new approaches to finding out why HIV reservoirs persist, and searching for keys to breaking these reservoirs down and eliminating HIV completely from the body is the work for today amongst HIV researchers. The HIV research community as a whole feels that a functional cure for the virus can be found soon, even if a complete eradication of the virus is still a ways off yet.